Inspection on 15/05/07 for Sunnyside Nursing Home

This inspection was carried out on 15th May 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Sunnyside Nursing Home 27/08/08

Sunnyside Nursing Home 30/11/07

Sunnyside Nursing Home 27/06/06

Sunnyside Nursing Home 17/01/06

Sunnyside Nursing Home 01/09/05

Sunnyside Nursing Home 31/03/05

Sunnyside Nursing Home 08/11/04

Sunnyside Nursing Home 10/08/04

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

CARE HOMES FOR OLDER PEOPLE Sunnyside Nursing Home 6-8 Oxford Road Dewsbury West Yorkshire WF13 4LN Lead Inspector Tracey South Unannounced Inspection 09:30 15 /16th May 2007 th X10015.doc Version 1.40 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 Nursing Home DS0000045066.V333578.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 Older People. 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 Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnyside Nursing Home Address 6-8 Oxford Road Dewsbury West Yorkshire WF13 4LN 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) 01924 462951 01924 457870 northfields@leedscare.co.uk Northfields Care Homes Ltd vacant post Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Can accommodate two named service users under 65 years of age category DE. Can accommodate one named service user aged under 65 years of age category - DE MD PD. Can accommodate two service users under the age of 65 years but no younger than 55 years of age within the category MD DE. 27th June 2006 Date of last inspection Brief Description of the Service: Sunnyside is owned by Northfield Care Homes Ltd and provides nursing and accommodation for up to 30 people with dementia related care needs. The home is situated on the outskirts of Dewsbury, within easy access to the town centre. The home consists of a large detached building made up of two Victorian semi detached houses and a modern extension. There are single and double bedrooms available. There are four lounges, a dining room and a sun lounge. There is a passenger lift, which serves the ground and first floor. There are attractive gardens to the front of the house. Car parking facilities are limited as the road adjacent to the home is unadopted and is in a poor state, making access to the home difficult for people on foot and by car. There is a ramp to the main entrance. A planning application was submitted to open up the front garden and allow access to the building from the front and also accommodate car parking and enhance disability access. The first application has been rejected and an informal appeal has been made. A meeting is planned for 24th May 2007 with the Chief Planning Officer to discuss the matter further. There are two separate units within the home, which accommodate up to 6 people with challenging behaviour. The current charges at the home range from £352.92 to £1700 per week. Additional charges are made for transport, physiotherapy, dentistry, ophthalmology, personal shopping services, dry cleaning and laundering outdoor clothing, bookshop services, private telephone and television, clinic appointments, telephone in room, cost of external outings, hairdressing, chiropody and toiletries. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last key inspection in June 2006, the CSCI (Commission for Social Care Inspection) have undertaken a further two unannounced visits to the home. The first took place during December 06 and was carried out in order to check the home’s progress in meeting the requirements made during the key inspection. The outcome was that although the home was making some progress in respect of improving care plans and upgrading the environment, further monitoring by the CSCI was needed. The second visit took place in January 2007 after the CSCI received a complaint about the standard of care provided to a person who, prior to her death, lived at the home. The outcome of that visit resulted in a number of requirements and recommendations being made to ensure improvements were made to the care planning documentation and associated health care assessments and the need to communicate with relatives about issues concerning their loved ones. As part of this inspection, one inspector carried out visits over two days. The first, unannounced visit on 15th May 2007 started at 9.35am and ended at 5pm. The second visit on 16th May 2007 was announced and started at 9.40am and finished at 2pm. Alongside this, the staff at the home also provided information that was requested by CSCI about people who live at the home, the staff that work there, the service provided and any incidents or accidents that have occurred since the last inspection. The last inspection report was also consulted. Information from these have been used to help inform the judgements made in this report. Prior to this visit surveys were sent out to obtain the views of people who live at the home, their relatives and people’s doctors. Twenty three surveys were sent out to people living at the home, five were returned (four people were supported by their relative/representative in completing the survey). Thirteen surveys were sent out to relatives, one was returned. Three surveys were sent out to people’s doctors; one was returned. The inspector spoke to three people who live at the home although they were not able to express their views about the home due to their frailty. There were twenty-three people living at the home on the day of the visit. Care practice was observed at periods throughout each day. The inspector spoke with one visitor, a visiting specialist nurse, seven members of staff, the acting manager and the human resource manager for the organisation. The inspector would like to thank everyone for their assistance and hospitality during the inspection process. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Prospective people should be given up to date information about the home including what they can expect to receive from Sunnyside. This will then help them make an informed decision as to whether this home is the right home for them or their relative. Care plans need to be more detailed in describing what each persons needs are and the level of support they will require to ensure those needs will be met. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 7 Regular reviews of care plans must take place in order to ascertain whether that person needs have changed or remain the same. If changes are apparent consideration must be given as to the extra support they may require. More emphasis needs to be made on finding out about peoples’ social care needs so that people can take part in activities that they can relate to and enjoy. Staff must pay more attention to detail in providing people with the appropriate support they need to keep up their personal appearance, in terms of wearing clean clothes and that they have shoes and stockings on. Greater care is needed when administering medication so as to avoid careless mistakes being made which could result in people being put at risk. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The information is not available to help people make an informed choice about whether or not the home is right for them, as the Statement of Purpose has not been amended for some twelve months. EVIDENCE: The Statement of Purpose that is used to inform people of what they can expect from Sunnyside is not up to date. A copy was given to the inspector during the visit and examined as part of the inspection process. The document has not been updated since the new owners took over in April 2006. Sunnyside offers ‘specialist care’ to people who exhibit challenging behaviour, which, in most cases is funded by the local NHS Primary Care Trust. There is very little written in the statement of purpose that informs people of what that ‘specialist care’ involves. The statement of purpose must be amended to ensure people are fully aware of what they can expect from the home in order Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 10 to help them make an informed decision as to whether Sunnyside is right for them or their relative. Because the home has not admitted any new people since the last key inspection in June 2006 it was not possible to speak to people who had recently moved to Sunnyside in order to find out whether the information provided was helpful. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans do not provide enough detail about peoples needs including the level of support they require and people are potentially at risk because of the poor systems in assessing health care needs and carelessness when dealing with medication. Peoples’ rights regarding their dignity is being compromised as a result of poor care practice. EVIDENCE: In March 2007 the organisation submitted an action plan to the CSCI, in response to the requirements and recommendations made in last report dated January 2007. It gave details of how and when the necessary work would be completed by. Written assurances were given that a new care plan format had been agreed and that weekly audits of care plans would take place. The action plan also indicated that all health care assessments such as assessments used to identify those people at risk of developing pressures sores, nutritional assessments, wound charts and fluid charts would be audited on a weekly basis. From evidence gathered during this visit to the home it was clear that Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 12 very little progress has been made and the shortfalls in care plans and health care assessments remain. This means people are at risk of not having their health and welfare needs met. Three peoples’ care records were examined in detail. None of the care plans provided sufficient details about peoples’ health, personal and social care needs. Two care plans had not been reviewed since January/February 2006. Daily reports do not provide enough information to confirm that peoples’ needs have been met, and there is no real indication as to how people have spent their day. Some people who live at Sunnyside are cared for in separate units within the home because they are known to exhibit challenging behaviour that may pose a risk to themselves or others. However, there is very little detail within any of the care records to explain what the specialist care is that they receive. Nutritional assessments are used to monitor peoples’ dietary requirements and identify those people who may need extra support in maintaining a healthy diet. One assessment did not reflect the needs and support required of one person who has swallowing problems and more recently has developed pressure sores. People are not being weighed in accordance with their assessed need. Assessments are used to identify those people who are prone to pressure sores. One person requires turning in position every two hours during the night to prevent pressure sore damage but there was very little evidence in place to confirm this actually takes place. Two peoples’ pressure care assessments had not been reviewed for the past three months despite both being assessed as a high risk of developing pressure sores. There was a number of errors in the calculation of scores. The scores determine whether someone is a low/medium/high risk. Miscalculation of this nature could put people at risk. On a positive note staff had made a referral to the specialist nurse for someone who has recently developed pressure ulcers. The inspector spoke to the nurse who said she felt that the staff had acted promptly in making the referral to her, and as a result a specialist bed and mattress was provided within a couple of hours of her visit. People at the home have access to health care services. Records of doctor’s visits are maintained, as are other medical visits and appointments. Staff at the home receive support and advice from the Community Psychiatric Team as and when they require extra support in caring for people who have become very unsettled, depressed or exhibiting challenging behaviour. The completed GP survey returned to the Commission indicated that they were satisfied with the overall care provided to people at Sunnyside. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 13 Surveys completed by people living at the home indicated that they generally thought they received the medical support they needed. Although one person commented, “Its sometimes a while to sort out things like dentist and optician”. Whilst examining the care records it was clear that risk assessments are not being implemented, as they should be. There was no risk assessment in place for one person who is known to fall out of bed frequently. There was no risk assessment in place for another person who is known to hit out without warning or provocation. This needs to be addressed to ensure that identified risks are managed effectively and measures are put in place to eliminate or reduce potential incidents from happening. Four peoples’ medication records and supplies were checked. There were six discrepancies where medication could not be reconciled with the records. This is even more worrying as the medication is supposedly checked every week. Care practice was observed during periods of the first visit and briefly on the second day. Some people looked unkempt, stains were noted on peoples clothing, people were without shoes or socks. At lunchtime staff were assisting some people with their meals and were wearing blue plastic gloves. When questioned about this staff explained that they were instructed to do so by their NVQ assessor. It later transpired that staff had been advised to wear the gloves whilst serving food but not whilst assisting people with their meals. To see people being assisted in this way was far from dignified. More alarmingly one person was observed being pushed in a wheelchair with their feet dangling whilst the carer had tipped them back onto two back wheels. The inspector told the member of staff that such practice was unsafe; she explained she had tipped the person back as he wouldn’t lift his feet off the floor. The wheelchair did not have footrests in place in order to assist him with the staff member’s request. This is not the first time the inspector has commented on the need for wheelchairs to have footrests on. This was not only unsafe but also very undignified and possibly frightening for the person being transported. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although some progress has been made in providing outings for people, their social care needs are not always being identified which makes it difficult for staff to engage people in activities of their choice. People receive a well balanced diet and are able to maintain contact with their relatives. EVIDENCE: As mentioned in the previous section of this report peoples’ social care needs are not being acknowledged as part of the care planning process. There was very little evidence in place that peoples’ past interests and hobbies have been explored and identified in order to engage people in activities that match their preferences. There is very little written in the care plan about peoples’ preferred routine and daily reports don’t give an insight into how each person has spent their day. It is therefore very difficult to establish just how peoples social care needs are being met. One member of staff spoken with was able to demonstrate a good knowledge of what people on the ‘units’ like to do. She explained that she has spoken with relatives and uses the information she has Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 15 gained when chatting to people. Unfortunately this information hasn’t been written down anywhere to enable other staff to do the same. As part of the surveys sent to people living at the home they were asked if there are activities arranged by the home that they can take part in. Two people indicated there ‘usually’ was, two people said ‘sometimes’, and one person said ‘never’. One person commented, “there are not often activities arranged, but I understand more are going to be in the future”. The home seems to be making more of an effort in recognising the need to celebrate special occasions such as birthdays – this was mentioned as part of the visit in January 2007. Birthday cakes are presented to each person and the cook has made a list of peoples’ likes and dislikes to assist when preparing their birthday tea. One daily report included the fact that a particular person had enjoyed a piece of their birthday cake. Staff explained that outings have begun to take place on a more regular basis and a number of people have been on trips out in the past three weeks. Trips out have included visiting the local park, Ponderosa Farm, and shopping. Some people have ventured only as far as the garden but this is acknowledged as a huge step for that person in terms of stepping outside of the home. An activities person visits the home for an hour every week and encourages a number of people to take part in gentle exercises. Visitors are welcome at the home at any reasonable time. The acting manager explained that the home does not receive a lot of visitors and from examining the visitors’ book it was clear that they are only a few people who visit regularly. One relative who was visiting the home said she comes to see her relative each week and is happy with the care he receives. She said she has no concerns about the home whatsoever. A mealtime was observed and the majority of people had their meals in the main dining room. The meal served was fish and chips and an alternative meal was available for those people who need more of a soft diet. People appeared to enjoy their meal. Staff were seen supporting some people with their meals. The issue about staff wearing blue gloves has already been raised in the previous section of this report. All five surveys indicated that people are more than happy with the meals at the home. The completed relative survey also indicates that the meals at the home are “excellent”. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident that their complaint will be dealt with but service users are not being properly protected. EVIDENCE: The complaints procedure is displayed in the front entrance of the home. Returned surveys indicated that people know how to make a complaint. One visitor spoken with said that if she had any concerns about her relatives’ care she would speak to who ever was in charge. She did say however, that she had no concerns about the home whatsoever. The home has introduced a ‘compliments’ and ‘niggles’ book where people are invited to write down their comments about the home. One person had made a comment in the compliments book regarding improvements made to the décor in the home. The home has received one complaint during the last twelve months. The complaint was sent direct to the CSCI and resulted in the inspector carrying out a visit to the home during January 2007. The outcome of the visit resulted in a number of requirements being made about improving information recorded in peoples care plans, health care assessments, risk assessments and medication records. Many of these have not been complied with. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 17 Training records indicate that since June 2006, twenty-seven people have received adult protection training. The training provided consists of staff watching a training video followed by the completion of a questionnaire in order to demonstrate their understanding of issues around safeguarding vulnerable people. The organisation indicated in the information sent to CSCI that the home has its own adult protection procedure, which covers the reporting of incidents/allegations of abuse. The lack of assessments to identify risk from people’s behaviour, the poor movement and handling practice seen, and the lack of attention to people’s personal appearance and dignity indicates that people are not protected at Sunnyside. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ living accommodation has improved as a result of the continuing work to upgrade the home in terms of the décor and the replacing of fixtures and fittings. EVIDENCE: A number of alterations to the layout of the home and the décor have taken place since the last visit in January 2007. The layout of the reception area has been altered and redecorated. Corridors, a lounge, and the dining room on the ground floor have been redecorated and new flooring fitted. A number of bedrooms have also been redecorated. Staff explained that measurements have been taken for new bedroom curtains. Toilet and bathroom areas have been refurbished. An old unused bathroom has been turned into a wet room and the old ‘toilet block’ has been redesigned as a disabled toilet. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 19 There is still a long way to go in terms of upgrading the whole house to a good standard. Staff explained that it has been very chaotic at the home with having to deal with rooms being shut off and workmen being present, and some people have become quite agitated with the disruption although this seems to have settled down. The “wet room”, a large shower room, needs the lock replacing to ensure the door is accessible to staff in the case of an emergency. Staff explained that hot water outlets in bathrooms have been fitted with preset valves to prevent people from scalding. However, it is good practice to check bath temperatures regularly to ensure the hot water is provided close to 43oC. The acting manager said she was not aware that such checks are being carried out. A recommendation is made to encourage the organisation to carry out such checks on a regular basis. Improvements to the décor have resulted in the ground floor accommodation looking much cleaner and brighter. However, there remain a number of carpets that are heavily soiled. The inspector noticed that spillages are not dealt with promptly; crushed biscuits had been left on a carpet with no attempt by staff to clean it up. The manager explained during the second day of the visit that a number of staff have been allocated areas of responsibility and that the cook has been given the responsibility of leading the domestic team. The manager said that she has taken on her role positively and issues about general tidiness in the home will be addressed. Surveys completed by three people living at the home felt that the home is ‘usually’ kept clean whilst two people thought that it is ‘always’ kept clean. The home employs designated laundry staff, who are responsible for the laundering of all washing including peoples’ personal clothing. A tour of the home included the laundry area, which looked very well organised and all the washing for that day had been completed by that afternoon. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are being recruited without having undergone a thorough recruitment process. Although staff are receiving training, the standard is inadequate and not all staff are not competent. This means that people, including staff could be potentially put at risk. EVIDENCE: There are currently twenty-three people living at the home, six of which live between two separate units based within different parts of the building. Between the hours of 9am until 9pm the staffing levels are, 1 trained nurse and three care staff. The night shift consists of 1 trained nurse and 1 care staff. The inspector raised concerns about staffing levels at night, as it does not appear to be enough. The night nurse has medication responsibilities from 10pm onwards, leaving one care assistant for seventeen people. The manager was asked to look into peoples needs at night to ensure that these staffing levels are appropriate in order to meet peoples needs during the night. The manager’s hours are supernumerary so are not included in the hours provided for direct care. In addition to this eight hours of supernumerary time is given to one of the nursing staff each day (Monday-Friday). The idea of the supernumerary hours is to enable effective management of the home. The Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 21 home also employs kitchen, domestic, laundry, admin and a maintenance team. There are twenty-four care staff employed at the home and thirteen (54 ) have achieved an NVQ level 2/3 qualification in care. Five staff files were examined; some progress has been made in making the files more accessible for the purposes of inspection as recommended in the last inspection report. Only two out of the five files examined contained two written references about peoples’ suitability to work with vulnerable people. Although two references were later sent to CSCI there remain shortfalls. One staff member had in place a reference that had not been taken from their previous employment. CRB (Criminal Records Bureau) checks had been carried out in respect of all new staff prior to them starting work. According to the training records staff have received a number of training sessions since the beginning of this year. But as the records were examined further it was noted that staff had received person centred care training, fire prevention, health and safety and infection control all within the same day. The training consists of watching a training video and then completing a questionnaire. Such an approach to training is far from ideal as it is a lot for staff to take in, in one day. Observations made during this visit, for example compromising peoples’ safety when using wheelchairs, wearing gloves to help people with their meals, and not paying attention to peoples’ appearance confirms this point. The registered person must ensure that all staff are competent to do their jobs. The manager explained that a recent development is that all new staff undergo induction training in accordance with the Skills for Care standards (this is the national training organisation for care workers). New staff are expected to complete this training within the first twelve weeks of their employment. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is not well managed and peoples’ health, safety and welfare could be compromised by the lack of safe working practices in place. EVIDENCE: The home does not have a registered manager. The acting manager is Mrs Jenny Stanley. Mrs Stanley explained that she has submitted an application to become the registered manager at the home, which is currently with the CSCI’s registration team. Mrs Stanley has worked for the organisation previously when she was the registered manager at West House, Dewsbury. She has a number of years experience of working in both residential and community settings. Prior to taking up the post as acting manager at Sunnyside she worked for the Alzheimer’s Society. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 23 Staff spoken with said Mrs Stanley is supportive and approachable. One person said it has been difficult for the staff at Sunnyside as there have been a number of different managers over the past two years. They explained how difficult it is when a new manager takes over with new ideas but having said that they felt that Mrs Stanley was prepared to listen to their ideas about what works well in the home. The organisation has recently appointed a new Operations Manager, as the previous person left in April 2007, who will be responsible for carrying out monthly management visits at the home. The purpose of the visit is to check that the home is operating well and time is spent talking with people who live at the home as well as staff. A report on the findings is then produced which is made available to the CSCI upon request. There were no reports available for the inspector on the day of the visit and copies were requested, to reach the CSCI by Friday 18th May 2007. Only one report was received on 18th May 2007, and referred to a visit taken place on 11th May 2007. In the absence of previous reports it is difficult to establish the level of management input the home has received since January 2007. To assist the CSCI in monitoring the shortfalls outlined in this report the organisation must forward all future copies of Regulation 26 reports to the CSCI Leeds office, until further notice. The inspector was advised following the last key inspection that a new quality assurance system would be implemented in January 2007. The manager explained that a small number of people have been supported to complete satisfaction surveys and in March 07 four relatives were given surveys to complete about the laundry system at the home. The manager said that she has recently given the completed surveys to the owner who is going to analyse the comments and then report back with the findings. There was a lot of confusion around how the quality assurance system will work. Staff need to be able to demonstrate a better understanding of how the quality assurance system is designed to work as they were unsure at the time of this visit. Further work is required in achieving a good quality assurance tool that actively seeks the views of people involved in the home, as there was very little evidence that this is happening. Small amounts of monies are kept on behalf of people at the home. Individual records are kept and receipts were available for monies spent. Three peoples monies were checked; two were correct. The manager explained the reason why the third was incorrect, which was resolved on the day of the visit. There was very little evidence of any safe working practices taking place. There was no certification in place to indicate that health and safety checks including the maintenance of equipment take place. The manager said the maintenance checks do take place but she was unsure as to where the records Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 24 were kept. This must be remedied and the CSCI must be informed of the dates of when equipment and safety checks have been carried out. Fire records were examined and up until 25th April 2006 weekly alarm tests have been carried out. Since the person responsible for doing the checks left the home they have not been done. There was no record of a recent fire drill and the manager was advised to make arrangements for one to take place the following day. Confirmation that this had been done was sent to the CSCI on Friday 18th May 2007. Staff explained that the fire officer had recently visited the home and left written instructions of the work required and will return again in August 2007 to monitor how progress is being made. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X x X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4&6 Requirement Timescale for action 31/07/07 2 OP7 OP18 15 The statement of purpose must be amended so it gives, up to date information that people need to make an informed choice about where to live. Each person must have a care 31/07/07 plan in place that reflects their current needs so staff are clear about the level of support each person requires. Timescale of 30.8.06 not met. Care plan reviews must take into account any significant changes. Amendments to the care plan must be made as appropriate. Timescale of 28.2.07 not met. 3 OP8 OP18 13 Health care assessments such as nutrition, moving and handling and pressure care assessments must be regularly reviewed and revised as peoples needs change to ensure they receive the level of support required at that time. If someone is assessed as needing weighing every week this must be done. 31/07/07 Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 27 4 OP8 OP18 13 5 OP9 13 6 OP10 OP18 12 and 13 7 OP12 16 8 OP19 23 People who are identified as being at risk, for example, from falling out of bed, as a result of not wearing footwear or who pose a risk to others must have a risk assessment in place. The risk assessment must include the measures in place for managing the risk effectively. Timescale of 28.2.07 not met. The nurse trained staff must take greater care when administering medication, as a number of medication supplies could not be reconciled with the records, and no explanation other than carelessness could be given for the errors noted. Peoples rights to privacy and dignity must be upheld at all times, for example, by supporting people to maintain their appearance, whilst supporting them with their meals and transporting them safely and in a dignified manner. Every effort must be made to establish peoples preferred routines and social interests and such information must be recorded in their care plan to ensure their social care needs are being met. Upgrading of the home must continue in order to provide people with a safe and wellmaintained environment, which is homely and comfortable. An up-to-date redecoration programme including timescales for completion must be sent to the CSCI by 30.7.07. 31/07/07 30/05/07 30/05/07 30/06/07 30/07/07 Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 28 9 OP27 18 10 OP29 OP18 19 11 OP30 OP18 18 12 OP33 26 13 OP33 24 14 OP38 23 The manager is required to confirm in writing that the staffing levels at night are appropriate to meet peoples’ needs. The registered person must not employ a person to work at the care home unless two written references are received and where applicable one must relate to the person’s last period of employment of not less than three months duration. The registered person must ensure that all staff are trained and competent to do their job safely and effectively. In order to monitor how the organisation intends to address shortfalls identified in this report and to ensure the home is run in the best interests of people who live there, copies of Regulation 26 reports must be sent to the CSCI Leeds office until further notice. The organisation must ensure that the quality assurance tool currently being adopted is focused on seeking the views of people associated with the home. The report referring to the recent submission of surveys must be forwarded to the CSCI by 30th June 2007. Wheelchairs being used to transport people must be in good working order with footrests in place. 30/05/07 30/05/07 30/05/07 30/06/07 30/06/07 30/05/07 Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 29 15 OP38 23 Health and safety certification 30/05/07 must be made available for the purpose of inspection as the home’s evidence that equipment used in the home is maintained in good working order. Fire records such as weekly alarm tests, servicing of fire equipment and dates of fire drills must be maintained to show evidence that all staff are of the procedure to follow in case of fire. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 30 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 8. Refer to Standard OP7 OP19 OP25 OP26 OP38 Good Practice Recommendations Daily reports should describe how peoples’ needs have been met as well as outlining how they have spent their day. The lock on the wet room door should be replaced to ensure it is accessible to staff in emergencies. Hot water temperatures should be checked and recorded on a regular basis to ensure that water is delivered close to 43oC. Every effort should be made to keep areas in the home clean and tidy, any spillages should be dealt with promptly. It is an expectation that relatives, in particular the next of kin are informed of accidents/incidents involving their relative living in the home within a reasonable timescale. Sunnyside Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Nursing Home DS0000045066.V333578.R01.S.doc Version 5.2 Page 32 - 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!