Inspection on 27/08/08 for Sunnyside Nursing Home

This inspection was carried out on 27th August 2008.

CSCI found this care home to be providing an Adequate service.

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 30/11/07

Sunnyside Nursing Home 15/05/07

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Sunnyside Nursing Home 6-8 Oxford Road Dewsbury West Yorkshire WF13 4LN Lead Inspector Jean Dobbin Key Unannounced Inspection 27th August 2008 09:20 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.V370553.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.V370553.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 hayleyglover@tiscali.co.uk Northfields Care Homes Ltd Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Sunnyside Nursing Home DS0000045066.V370553.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. 30th November 2007 Date of last inspection Brief Description of the Service: Sunnyside is situated on the outskirts of Dewsbury and is a large detached building made up of two Victorian semi detached houses and a modern extension, with single and shared rooms, on two floors. The home provides nursing care and accommodation for up to 30 people with dementia related care needs. There are four lounges, a dining room and a sun lounge, and a vertical passenger lift to the first floor. A separate unit accommodates six people with specialist dementia needs, beyond that which the home manages. There are attractive gardens at the front of the house, though car parking facilities at the rear are limited. Access to the entrance, which is at the back of the building, is difficult because the approach is via an un-adopted road, which is in a poor state. There is a pedestrian ramp to the main entrance. The statement of purpose and latest inspection reports by the Commission for Social Care Inspection are displayed in the entrance area and are made available, from the manager, for people to look at. The weekly fees provided on 27th August 2008 are from £394 to £411 per week. This does not include the extra funding to meet nursing needs. Additional charges are made for transport, such as to the hospital or dentist, hairdressing, chiropody and personal toiletries. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This is what was used to write this report. • • Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection, and provided by the manager. This is called an Annual Quality Assurance Assessment (AQAA) Information obtained during a short ‘thematic’ inspection, carried out by the Commission for Social Care Inspection on April 24 2008. This short inspection looked at how well the home was protecting people from abuse. The findings from the inspection are included in the body of the report. Information from surveys, which were sent to people who live at Sunnyside, to staff and to other professional people who visit the home. 6 were sent to people at the home, and 2 were returned. 8 were sent to healthcare and social care professionals and 1 was completed and returned. 8 were sent to staff at the home and 3 were returned. A visit to the home by one inspector, which lasted about 8 hours. This visit included talking to people who live there and their visitors, and to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. • • • Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 6 Information about what was found during the inspection was given to the manager at the end of the visit. What the service does well: What has improved since the last inspection? New staff do not start working at Sunnyside now, until all recruitment checks have been completed, to make sure they are suitable to work in a care setting with vulnerable adults. All new staff complete an induction programme, where the way the home runs and the policies it expects staff to follow are written down. This way all staff learn about the people living in the home by reading and discussing the same information to make sure everybody learns the same. The home has produced pictorial signs, like ‘toilet’, and ‘dining room’, which have been attached to the appropriate doors to try to help people find their way around and promote their independence. There has been some ongoing redecoration to improve the environment for the people there. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 7 What they could do better: The manager could make sure that information in care plans reflects what is recorded in the assessment of risk, so that it is clear why care has to be provided in a certain way. Care plans could be written in enough detail to say exactly what a person can do for themselves and what help and support they need. They could be written for all aspects of a person’s care, like continence and night time care. The way behaviours that challenge the service are to be managed could be written down in detail, so that care staff provide consistent support when providing this care. There could be a greater priority given to helping people to have a more stimulating and varied life. Stronger links could be made with the local community to promote events and activities within the home. The home could look at the present system of keeping people’s private rooms locked, to see if a better way would help people to stay in control of their lives more. The dining experience at the home could be looked at to see if changes would improve mealtimes and help to make them more of a relaxed social occasion. This includes whether people on the separate unit could sit at a table for their meals, to make it more of a social event. People’s food choices could be respected more, even if this means a less healthy meal. The laundry room floor and walls could be cleaned, and then painted in such a way that makes them easy to clean and therefore reducing the risk of the spread of infection. The manager could make sure that staffing levels in the main house are sufficient for people living in that area to have the same level of care and support as those living in the separate unit. The rota could be planned in such a way that there is always a carer on duty who, when talking, can be easily understood by the people living there. The manager could continue to encourage a more positive outlook within the home, so that staff feel part of a team, and are more enthusiastic about their work. The way some management responsibilities are dealt with could be much better. These include making sure that people with an interest in how the home runs are consulted, so they can say what works well and what doesn’t. Records of people’s monies could be monitored more closely to make sure all money is accounted for. The commission could be notified when an incident at the home affects the well being of a person living there. This is so that these events can be monitored. Bedrails could be fitted to the bed properly and then checked to make sure they stay on the bed as they are meant to. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 8 The manager could consult with the fire safety officer to check whether systems currently in place to keep people safe in the event of a fire at night are sufficient. 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.V370553.R01.S.doc Version 5.2 Page 9 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.V370553.R01.S.doc Version 5.2 Page 10 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): 3 and 6 People who use this service experience good quality outcomes in this area. People are assessed before they move to the home, so that they can be reassured that staff at the home can care for them properly if they choose to move there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Four care plans were looked at as part of the inspection process. Each contained a comprehensive assessment completed by social services, who fund the placement. Three out of the four did not contain an assessment by a senior person at the home, which would have confirmed that staff at the home could meet the person’s needs if they moved there. The care records are in the process of being changed and the manager presented one set of records in the new format, for a person who had moved Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 11 to the home in the last month. This file contained a comprehensive assessment, completed by the manager, looking at the person’s physical, emotional, and social needs. It provided enough information for the manager to determine that staff at the home had the skills and knowledge to support them appropriately. It also provided the information from which a plan of care could be written. The assessment recorded who was there when it was carried out, and included the signature of the person’s representative to show that they agreed with what was written. The manager said that he planned to make sure all people admitted to the home had this type of assessment and paperwork in place. The Statement of purpose and service user guide is displayed in the hall. The manager should also look at providing some of this information in a different, simpler format, which may help some people moving there to understand the kind of support the home can provide. This would show that the home is trying to support people and recognising that some people still have the capacity to make some decisions for themselves. Intermediate care is not provided at Sunnyside Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 12 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 this service experience adequate quality outcomes in this area. Whilst people’s health and personal care needs are generally being met the written care planning records which underpin this care are not always detailed enough or written in a consistent way. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Three care plan files were looked at during this visit. These describe the care and support people need to try and maintain a level of independence as far as possible. Whilst familiar staff may be able to find information easily this information was not clearly presented and the files were not easy to read. Only one of those looked at contained a photograph of the person, so an unfamiliar carer would struggle to know who was who. A fourth care plan, for a recently admitted person, was also looked at and the manager explained that this format was to be used for future admissions. This record included a photograph of the individual. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 13 The local authority carries out monitoring visits on all care homes, and earlier this year these visits identified significant shortfalls in both the care record keeping and care practices within the home. Monitoring visits have generally shown improvement, but at this time the local authority is limiting admissions to the home to one person each week, so that staff have the time to make sure records relating to the individual’s care are planned and implemented properly. The care files looked at on this visit did provide quite a lot of information that was individualised. Preference sheets identified some personal choices, such as liking to wear jewellery and what time someone likes to go to bed. One person was observed walking around with just socks on their feet, and their care plan said that this was something they liked to do. The care plans though were not written in a way that support people to maintain some control of their lives, for example ‘make sure nails are kept clean’ instead of describing how the person should be helped to keep their nails clean. They did not identify exactly how much help people needed. For example, whether someone could wash themselves independently, whether they could wash themselves if they were prompted, or whether they would not be able to wash themselves at all. Care records are needed so that staff provide consistent care and people can be supported in maintaining these life skills for as long as possible. There were also daily records in place to describe day-to-day events, and the care staff completed these. Assessments were in place for whether people were at risk of developing a pressure sore, or losing weight because of a health problem or not eating enough. Every person has a ‘food chart’, where what people eat each day is recorded, however this may not be necessary for those people who have a good appetite. The risk assessment should guide staff as to whether this is needed, rather than doing it for everyone. Other specific risk assessments were in place, but the plan of care for those people assessed as ‘at risk’ did not always follow on from the assessment, so it was not easy to understand how decisions had been reached. For example whilst every person was assessed for moving and handling the plans of care in those files looked at were inconsistent. One assessment said the person could be ‘asked to stand’ then in the care plan it stated that they needed two people to help them stand. Staff need accurate care plans to reassure them that they are providing the right care. Inconsistencies must be addressed so that the same care is provided to an individual, regardless of who is providing it. These risk assessments were however reviewed regularly to make sure the information was still relevant. Other care plans must be provided in detail, particularly when people may not be able to explain what help they want. Details about promoting continence and maintaining people’s dignity should be recorded. There was no Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 14 information about night-time routines, particularly important, as people are not able to use call bells at night. Many people at the home have behaviour that challenges the service. Details about these behaviours were not well recorded in the files that were looked at. A carer spoken with was very clear about how this behaviour starts, and how it is managed, but this was not recorded. There were good records of contacts with outside healthcare professionals, like the local doctor, physiotherapist and dentist. One person was using a special chair, which had been bought following an assessment by an occupational therapist. On the day of the site visit one carer was concerned that someone was more poorly than the previous day, when the doctor had visited. The nurse contacted the surgery to request another visit. One visitor spoken with said the home had contacted them promptly when there were any issues about their relative. Medication systems looked at were generally satisfactory. The home uses a system where the pharmacist dispenses tablets in weekly cassette packs. Drug administration charts were filled in correctly and new prescriptions, added to the chart by nursing staff had been signed and dated. The numbers of boxed tablets are counted each week to make sure the actual number is the same as the projected number as a way of checking that people are receiving their drugs according to their prescription. The fridge temperature is checked daily to make sure it is still working properly. The nurse said that blood sugar monitoring equipment is checked each week, but this is not written down. This needs to be written down, to show it is happening. Staff were observed supporting people in a courteous and respectful manner. People were addressed by their name and staff were seen distracting individuals so that their difficult behaviours settled down. One person though got up and walked across the room and staff repeatedly asked them to sit down. This person was not showing any difficult behaviour at that time, so it was unclear why this person could not go where they chose. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 15 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 this service experience poor quality outcomes in this area. People’s lives are not very interesting. Whilst the meals are satisfactory the way the whole dining experience is managed could be improved. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: From the care records people have the opportunity to get up and go to bed when they wish. The survey responses say that this is the case. Breakfast is available for more than two hours, so that people can have their breakfast whenever they get up. There is no activities person employed at Sunnyside though the manager says the post is advertised. People’s lives in the main house are not stimulating and there is little variety from one day to the next. There are three lounges and the television was on each lounge. This meant that in the main communal areas there was nowhere quiet for people to sit. There was no evidence of any past events, nor any radio, videos, or musical entertainment. The home has an organ and one person does play now and again. There were no homely Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 16 items like magazines and ornaments or visual things from an earlier generation, which may remind people of their past lives and provide a talking point. People’s social needs were poorly recorded in their care plans so staff do not know much about their past. This means it is hard for staff talk about things, which have some meaning to the individual. The hairdresser visits twice a month and a church choir visit fortnightly. Otherwise there are no other general visitors. There are no visits from the local clergy. One person filled in their survey, saying they were Roman Catholic, and a religious icon was displayed in their room, but the priest doesn’t visit. The manager said the person wasn’t practising, however this information was not recorded in their care plan. On the separate small unit people’s social needs were better addressed. There were newspapers and magazines and more carers to support a smaller number of people so staff had time to sit and talk with them. They knew the people well and they were observed looking through a photograph album, talking about the photos. People’s rooms contained older photographs and pictures. Subjects talked about meant something to the people so they were able to contribute to the conversations. One visitor spoken with said that they visit at different times and they are always made welcome and another has their lunch at the home most days. Some people at the home do not have any visitors and the manager should consider using local advocacy services so that people can have a person visiting who will make sure their rights are always respected. There were no details about local advocacy services displayed at the home, and this was discussed with the manager. People’s bedroom doors are all kept locked, once they have been cleaned so people cannot go to their own room on their own. The manager said this stopped individuals going into other people’s rooms, however this way of working does not promote people’s independence and choice. The manager also said they were reviewing this policy. People are offered drinks throughout the day. On the small unit people were offered fresh fruit, cut up, at coffee time and this was clearly enjoyed. The cook had baked scones for later that day. A visitor said fresh fruit was regularly provided. There is a four week menu, with choices available at each meal. The lunchtime meal was observed, when there was turkey, cauliflower, green beans and potatoes with meat pasty as an alternative, and spotted dick and custard for dessert. There is a large bright dining room, or people can have their meal in one of the lounges. On the small unit there is only one lounge area and with no dining table people have to eat their meals sat in their lounge chairs. This does not promote mealtimes as social occasions where people can be encouraged to speak a little with each other. However the manager says carers and their representatives were consulted in the decision not to have a Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 17 dining table. This needs to be clearly recorded in their care plan describing how people’s nutritional needs are to be met in Sunnyside. Carers were observed assisting in such a way as to promote people’s ability to feed themselves. The desserts though were served soon after the main course, so they were sat on a tray, going cold whilst people were eating their dinner. In the main house the meals were served from a hot trolley. All the meals seen were of about the same portion size, with no recognition of people’s different appetites. One person said they didn’t want their meal, so it was offered to someone else, whose care plan said they didn’t like meat very much. The person told the carer this, but after discussion said that they would try a bit. They asked for more gravy and the carer said they had some already. Then agreed to get them some more. This person said they liked sausages and their preferences were discussed with the manager. Staff at the home need to listen to people’s preferences and this includes people’s rights to eat unhealthily, if that is their choice. Another individual was given their dinner, but almost immediately afterwards was given their dessert. Once the carer left the room the person pushed their dinner plate away and started eating their pudding. Many of the people living there need help with their meals. Currently all the meals are served in one sitting, but the manager needs to look at whether that is the best way of making sure people receive the right support at the pace they need it. Some staff were observed sitting whilst assisting people, but one carer was standing up whilst helping. This is disrespectful to the person and does not promote a relaxed unhurried atmosphere. Pureed meals are presented with the different parts of the meal served separately so the person can enjoy different tastes. One person though had had their meal all mixed up together by the member of staff helping them. This should not be done unless it is documented in their care plan that this is the way they like their meals. One person spoken with said that the food is ‘very good’. They also said that they ‘get plenty’ and it was ‘as good as anywhere’. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 18 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 this service experience adequate quality outcomes in this area. People can be confident that complaints would be addressed and staff are alert to signs of abuse, however local safeguarding processes must be followed to make sure people’s welfare is protected. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints policy is detailed in the welcome pack, given to people and their families when they move to the home, as well as displayed in the entrance area of the home. People living there do not have access to this area though. Two people living there completed surveys, with help. One of these said they didn’t know what to do if they were unhappy about something. The manager could consider producing and displaying this policy in a simpler format so that people with some capacity can have some understanding of what to do if they are concerned about something. The home has received no complaints in the last year. It also keeps a ‘niggles book’, where more minor issues raised by people can be recorded. The visitor spoken with said that they had spoken to the manager about a small concern they had, which the manager had dealt with. This though was not recorded anywhere. The manager said this had not been a big issue, so did not feel the need to write it down anywhere. It is good practice to record any concerns, Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 19 however minor, so that possible ‘trends’ can be identified and action taken to address them. The care staff know most of the people very well and can recognise if individuals are unhappy by their behaviour. One carer explained that knowing people well, including their likes and dislikes means that that they can easily see if someone is troubled by something. A short focussed inspection by the Commission for Social Care Inspection was carried out at Sunnyside on 24 April 2008. This was called a thematic inspection and looked at how well the service makes sure people are protected from abuse. This inspection reported that overall people using the service were well protected. People said they felt safe, staff were recruited and trained properly in safeguarding people, and the home had good policies and procedures in place to make sure things were being done properly at the home. There has though been a large safeguarding investigation earlier this summer, alleging poor care practices and neglect at the home. This investigation is still not complete. The local authority carried out review assessments on all the people living there, and people’s relatives were asked to provide their views of the service. The outcome of all these meetings was that people were generally satisfied with the care provided by the home. One person spoken with said. ‘This is the best care setting (my relative has stayed in), the cleanest, my relative is always nicely dressed and I would say if I had any complaints. The training records, which the home keeps, shows that half the staff have not received safeguarding adults updating training for more than a year. Nevertheless one member of staff spoken with was quite clear that anything, which causes them concern, would be reported immediately to the nurse. They said that if a person living there told them something in confidence, then this would also need to be immediately reported. This is good practice as they recognise the need to report it regardless of what the person asked. They said they would feel no loyalty to a staff member, as people living there should be treated properly. The home is required to inform the commission of all incidents and accidents, which affect the well being of the people living there. One person recently had to attend hospital after being hit by another person, who was displaying behaviour that challenged the service. By not reporting this, the manager is not doing all he can to protect people. (see standard 31-38) Recruitment processes looked at showed that checks are carried out properly before people start working at the home. The manager should also consider using external advocates for people who don’t have visitors who can speak up Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 20 for them, as another way of helping to make sure people living there are kept safe. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 21 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 and 26 People who use this service experience adequate quality outcomes in this area. People live in a warm and comfortable home though the addition of extra furnishings and homely items would enhance this further. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is a large old detached building on the outskirts of Dewsbury, with attractive picture windows overlooking the garden. It was noted to be clean and tidy, though not particularly ‘homely’. A keypad is used to gain access. Reaching the home is not easy at this time as the road to the house is unadopted and in a poor state. The company have applied for planning permission, to improve this access. One person contacted the commission to say that getting into the home in a wheelchair was difficult, but the manager has now sorted this. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 22 The accommodation is mainly single rooms, though there are four shared rooms. These rooms are not shared at this time. Most bedrooms are on the first floor and there is a vertical passenger lift and a stair lift to reach this floor. The private rooms looked at had been personalised with photographs and other items that meant something to the individual. There are no call bells in use in the bedrooms, though pressure pads are used for a lot of people. These are mats that are placed at the side of the bed. If the person gets out of bed in the night and steps on the mat, this activates an alarm away from the room. Staff can then respond to people as necessary. The doors to people’s rooms are numbered, but are otherwise identical, although the manager said that doors are to be painted brighter colours, to make it easier for people to find their way around. Whilst those private rooms looked at were well maintained and carpeted, the decoration and furnishings in the communal areas and corridors downstairs are quite institutional. Although the floor covering is easier to keep clean than carpets, the manager should consider the use of other furnishings and furniture to make the home a more homely place in which to live. There is a sun lounge and safe outside space with seating, however this is away from the main sitting areas, where people and staff tend to be. Many people would be unable to find their way independently, because of the layout of the home although pictorial signs are used try to help people to find their way around. On the small unit, which is accessed by a second keypad, staff were seen undercoating people’s doors, prior to painting them in bright colours. The plan was to support people in painting their own doors, though this process hadn’t yet started. Unlike in the main house people’s doors are left open so that people can move around the unit as they choose. The communal area on this unit has no dining table though, and sitting at the table for meals would promote a social occasion. There were no unpleasant smells noted in the building. Staff were observed using protective wear when helping people with personal care. A member of staff said that these items were available. The laundry area was looked at. The person working there said that they were always informed if there was any infection in the home, and infected laundry was managed appropriately. The laundry room floor has been repainted earlier this year, but appliances were not moved for this to be done. This means that areas of the floor are not protected properly and satisfactory standards of hygiene cannot be maintained. The pipe work on the walls are covered with a lot of fluff from the driers and this also needs cleaning and maintaining. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 23 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 this service experience adequate quality outcomes in this area. People are cared for by willing staff, who have received training and are recruited properly, but who lack direction, following recent management changes at the home. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: At Sunnyside there is always a trained nurse on duty. During the day and evening there are seven carers working and at night, four. On the small unit there are three care staff on each day shift and two at night. This leaves four on each shift and two at night in the main house. The rota generally confirmed this. A senior nurse has also recently been appointed. She has some unrostered time, but plans to work with care staff to make sure they are giving the most appropriate care to the people living there. On the day of the site visit the staff on the small unit had time to sit and interact with people. In the main house the carers seemed more busy and did not have this time. Some people’s behaviours became difficult and carers had to manage that behaviour, rather than being available when the individual Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 24 started to get upset. Also because of the layout of the communal rooms it was difficult for one carer to ‘keep an eye’ on everyone, to try to minimise the risk of behaviours becoming challenging. The manager needs to look at the staffing levels to make sure that people in the home are able to receive the same level of support and supervision regardless of where in the house their room is. Care staff work in one area of the home all the time, wherever possible, so they can get to know people there better and understand what individual behaviours may mean. The staffing levels on the small unit provide opportunities for staff to work closely with people, monitoring their behaviours and providing distraction if the behaviour becomes challenging. Most staff have attended dementia awareness training. One person has attended extra training in dementia care and has lots of ideas about how to improve the lives of the people living there. Other care staff in the main home need to attend this training. This could improve their knowledge of good dementia care practices and how they could make a difference to the lives of the people living there. Although one carer said ‘staff need to be better educated about person centred care’ another wrote ‘the service provides adequate support to meet the service users’ needs’. The manager has a record on the computer, stating when staff need training updates. A lot of this training needs to be provided again in September, though no dates have been arranged yet. The manager states that more than 50 of care staff have achieved a National Vocational Qualification Level 2 in Care, however the record provided by him does not support this. People are more likely to be cared for in a safe consistent way by carers who have this qualification and a good understanding of their role. The home has needed agency staff to cover nearly 200 shifts in the last three months. This is said to be because the previous manager agreed to too many care staff taking leave over the summer period. The manager also says that one agency provided this cover, so that there was some continuity for the people there. The manager says that the home has recently recruited more staff, which should make sure agency staff are not required in the future. The home employs a number of care staff whose accents may be difficult for some people to understand. The manager and staff need to be alert to the fact that people may become more frustrated and upset if they don’t understand what is being said to them. There have been a number of different managers in the last few years and these changes have adversely affected the morale of staff working there. The staff generally do not feel valued and a lack of consistent leadership has affected the way they work together. There is a culturally diverse staff group Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 25 and language barriers can affect communication both within the team and with the people living there. The files for two members of staff who have recently started work were looked at and both showed that all the legal checks had been completed properly before they started work. This good practice helps to keep people safe. The home now provides an induction pack for new staff, which they work through. This covers care practices as well as information about the home’s policies and procedures. This makes sure that the induction is provided in a consistent way. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 26 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 this service experience adequate quality outcomes in this area. Although people have their care needs met the lack of proactive management and good quality monitoring schemes means that the home is not being well run. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There have been several managers at Sunnyside in the last two years and this has caused some staff to feel disillusioned and not well led. The organisation has placed one of its senior managers in day-to-day charge of the home, whilst a permanent manager is appointed. This should help staff to feel more supported and valued, however one person said in their survey that ‘the staff Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 27 in the organisation need to communicate effectively and pass relevant information on’. The organisation has appointed a new manager who has not yet started, but one carer spoken with didn’t know that. Another carer though said she gets a lot of support from the manager, so that she can make changes to the way people are cared for. Although the manager nis available for people to speak with, his office is not in a part of the building, which is accessible to people living there. The manager has only had day-to-day charge of the home for a few weeks and has been concentrating on addressing some of the shortfalls identified by the local authority’s monitoring visits. However he has carried out monthly monitoring visits on the home in the past, in his senior role as Operations Manager for the organisation. He was however still unaware of some processes in the home. For example the cooks start work at 6am each morning, but the manager had never found out why. Also when it was suggested that the staff room notice board be used to keep staff up to date with what was happening, the manager admitted he had never visited the staff room. The manager, whilst walking around the home each day, needs to keep talking to people living there and to staff, both to see what’s going on, but also to be available for staff to speak to and to re-build their confidence. Although the organisation has a quality assurance system, relatives and professionals who visit the home have not been asked for their views about how the home runs recently. People living there have been supported in completing forms about what works well at the home, however other people need to be asked as well. The deputy manager has put systems in place so that medication checks are carried out regularly. These checks need to be extended to other areas of how the home operates so that the way it runs can be monitored properly. The home keeps small amounts of people’s monies on their behalf. The manager does not hold responsibilities for people’s monies and people’s families are invoiced for items like hairdressing. Although receipts for items bought are kept, these are not kept in an orderly way, so are not easy to check. In both cases looked at, the paper record did not agree with the actual amount of money in the individual’s purse. In both cases the difference was less than a pound, however the record keeping does not demonstrate that people’s finances are being safeguarded. These monies need checking regularly as part of a system to show that the home is being run properly. Some health and safety records were looked at, although these were not easy to find. Moving and handling equipment safety certificates were in date, electrical checks on small items had been completed and the legionella screen was up to date. Generally the compulsory training provided to staff so that people’s health and safety is not put at risk was up to date, although few staff have completed first aid training. The fire safety records were also difficult to locate, but showed that checks have been completed appropriately. Most staff Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 28 are due up-dated annual fire safety training within the month. Although a fire risk assessment was up to date, people generally are unable to use a call bell at night, to summon help, and there are no night time care plans looking at people’s safety. Following the visit the fire safety officer in Kirklees was contacted and he agreed to visit to look at whether the home needs to be doing more to keep people safe at night. Two people living there had bedrails on their beds. On one bed the end of the bedrail was positioned such that a person in bed could be at risk of trapping their head between the bed head and the start of the bed rail. The manager addressed this straight away, however checks need to be carried out to make sure the bedrails stay in the right position, and staff need to know what they are checking for, and why. The second had bedrails built into the structure of the bed, however a pressure relieving mattress had been used, which raised the level of the mattress to just below the bedrail. This means the person was at risk of falling over the top of the rail. Both the manager and nurse felt that bedrails were not needed for this individual. People need to be assessed properly to decide whether this type of restraint is required. They should not be used otherwise. The accidents record looked at showed that earlier this year one person hit another, who needed to go to hospital, although no treatment was required. The manager says this incident was reported to the commission, though there is no record of this. However this incident was not reported as a safeguarding alert to the local authority. If this had been done then an action plan could have been put in place and the notification not reaching the commission, for whatever reason, would not have affected the safety of people at the home. By not sharing this information as required by the local authority Safeguarding Vulnerable Adults policy the manager is not doing all he should be doing to keep people safe. Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 29 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X X 2 Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 13(4) Requirement Where people have been assessed as ‘at risk’ of harm, the care plan addressing how this risk is to be minimised needs to be written in a way that is consistent with the completed assessment, to make sure people receive consistent help. Care plans describing how behaviour that challenges the service is to be managed must be written in sufficient detail, so that carers can provide the right support when that situation arises. People must be given the opportunity to engage in stimulating activities that meet their expectations. Previous timescale of 30/12/07 not met The whole dining experience must be reviewed to make the care and support provided at mealtimes more individualised. This includes: Recognising people’s likes and DS0000045066.V370553.R01.S.doc Timescale for action 31/10/08 2 OP8 13(4) 31/10/08 3. OP12 16(2)(m) 30/11/08 4. OP15 16(2)(i) 31/10/08 Sunnyside Nursing Home Version 5.2 Page 31 dislikes, and their right to eat what they would like to eat. Providing help in a way that respects people. Providing puree meals where people can taste the different flavours Ensuring hot meals stay hot until they are ready to be eaten Enabling people on the separate unit to sit at a table for their meal if they choose. 5 OP26 13(3) The whole of the laundryroom floor should be protected in such a way that it can be easily cleaned the limit the risk of a spread of infection. The staffing levels at the home must be reviewed to make sure people living in the main house are able to receive the same level of care and support as those in the smaller separate unit. People with an interest in how the home operates must be consulted so that they have the opportunity to say how they think the home runs and how it can be improved. The home must have robust ways of demonstrating that people’s monies are being looked after in a responsible manner. Bed rails need to be fitted to the bed, checked and maintained according to MRHA (Medicines and Healthcare products Regulatory Agency) guidelines. This will help to keep people safe. The manager must consult with the fire safety officer to see if DS0000045066.V370553.R01.S.doc 30/11/08 6 OP27 18(1)(a) 31/10/08 7 OP33 24(1) 31/10/08 8 OP35 17(2) Sched 4 13(2)(c) 31/10/08 9 OP38 30/09/08 10 OP38 23(4) 30/09/08 Page 32 Sunnyside Nursing Home Version 5.2 11 OP38 OP18 37 the home is doing all it can be doing to keep people safe particularly at night, in the event of a fire, The manager must share information with the local authority and the commission about any incident where one person is harmed by the behaviour of another person. This is so that these incidents can be monitored and professionals can work together to keep people safe. 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The care plans could be written in a way that enables people to maintain independence and describes in detail what they can and can’t do. The record should include a care plan about every care need so that people receive support in a consistent way from all staff. The practice of keeping people’s bedrooms locked during the day should be looked at to see if a better way would provide people with more control and choice in their lives. The manager could consider using an external advocate for those people who don’t have any visitors. This would make sure that someone not working at the home is making sure their rights are always being protected. There could be some consideration made to making the communal areas more homely and providing a quiet room, for those people who don’t like the television. The organisation should continue working towards 50 of the care team having a NVQ qualification so that people are supported by staff who have a good understanding of their role. The manager could look at how communication within the home could be improved so that staff know what is going on and they feel valued and supported. DS0000045066.V370553.R01.S.doc Version 5.2 Page 33 2. 3 OP14 OP18 4 5 OP19 OP28 6 OP31 Sunnyside Nursing Home Sunnyside Nursing Home DS0000045066.V370553.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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