Inspection on 31/07/07 for Sunnyside Residential Home

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Residential Home 15/06/06

Sunnyside Residential Home 10/03/06

Sunnyside Residential Home 12/01/06

Sunnyside Residential Home 28/02/05

Sunnyside Residential Home 02/09/04

Similar services:

Chirnside House

Sunny Bank (P.R.S.) Ltd

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

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

CARE HOMES FOR OLDER PEOPLE Sunnyside Residential Home 37 Ullet Road Liverpool Merseyside L17 3AS Lead Inspector Manidipa Choudhury Key Unannounced Inspection 31st July 2007 10:00 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 Residential Home DS0000025381.V341453.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 Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnyside Residential Home Address 37 Ullet Road Liverpool Merseyside L17 3AS 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) 0151 733 7070 sunnysidehome@hotmail.co.uk Mr Wood Mrs Wood Mr Wood Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (17), Physical disability (17), Physical disability over 65 years of age (17) Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Two named service users under 65 years old, within the overall number of 17. To provide care for one named person with mental disorder, under 65 years of age. 15th June 2006 Date of last inspection Brief Description of the Service: Sunnyside is a residential care home providing 24 hours personal care and accommodation for 17 older and disabled persons. Sunnyside is located in a quiet residential area of Liverpool close to Sefton Park. The home is within easy access to bus routes, churches, shops and other local amenities. The home is a three-storey building with gardens to the front and rear of the premises. Communal space comprises of two lounge areas and a spacious dining room. Bedroom accommodation is situated on all three floors, which are serviced by a passenger lift. All the bedrooms are single with high quality furniture and fittings. Fifteen bedrooms have en-suite facilities and all bedrooms are connected to a staff call system. Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which lasted for eight hours. During the inspection three residents, two staff and the deputy manager were spoken to. In addition three resident’s files and three staff files were examined to ensure that the necessary records that the home is required to keep were systematically maintained and where necessary reviewed. Also, other records relating to promoting service users and staff health and safety were inspected. A tour of the building was also carried out to assess the quality of the accommodation provided to service users. The weekly fees at Sunnyside range between £335.50 and £410.00 What the service does well: What has improved since the last inspection? What they could do better: All residents should be issued with Sunnyside terms and conditions. All residents should be assessed before they are admitted to the home. Resident’s care plans and risk assessments should be more detailed showing how service user needs would be met. Care plans and risk assessments should be monitored closely and reviewed at regular intervals. The care home would benefit from keeping an accurate and systematic record of all activities Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 6 arranged for the residents. Fire records should be accurately recorded and kept in a systematic manner. 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 Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 7 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 Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 8 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): 1,2,3,4, and 5. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents move into the home without having their needs assessed and therefore the care home cannot assure residents and their representatives that their comprehensive health and care needs will be appropriately met by the home. EVIDENCE: The Statement Of Purpose has been reviewed in 2007. However, it needs to be amended to include the following points mentioned in schedule 1 of the Care Standards Act – (a) (b) The home does not provide nursing care The fire precautions and associated emergency procedures in the care home DS0000025381.V341453.R01.S.doc Version 5.2 Page 9 Sunnyside Residential Home (c) The arrangements made for dealing with reviews of the resident’s care plan The home does not provide intermediate care, but do provide respite depending on availability of space. The deputy manager said that all prospective residents and their relatives are offered the opportunity of a trial visit to the home to assess the quality, facilities and suitability of the home. Majority of the prospective residents come for a trial visit, but sometimes family members will visit on their behalf. The home has some privately funded residents. Three resident’s files were case tracked. One service user’s contract could not be found. Another privately funded resident’s contract could also not be found. The registered manager is required to ensure that each resident is provided with a written contract/statement of terms and conditions at the point of moving into the home. Three resident’s files were case tracked. Pre-admission assessments could not be found on any of them. The registered manager must ensure that no residents move into the home without having his/her needs assessed and been assured that these will be met. The deputy manager said that apparently the care home does not have an appropriate format for recording pre-admission assessments. This needs to be addressed immediately, as the resident’s care plan needs to be based on a comprehensive and holistic assessment. A resident’s survey was conducted by CSCI. Seven residents completed survey forms. Four of the seven residents have said that they have not received a contract/statement of terms and conditions from the home, two have confirmed that they have received a contract and one resident says that he/she is unsure. When asked whether they received adequate information about the home before moving in, 4 residents said that they had. Three residents said that they had not received enough information about the home before moving in. One resident has commented that “I was just sent by the hospital”. Another resident has commented that he got the information from “Fazarkley hospital”. Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The resident’s care plan is not generated from a comprehensive assessment, risk assessments are not comprehensive and care plans are not reviewed on a monthly basis. Therefore the health, personal and social care needs of the residents are not always appropriately met. EVIDENCE: Three residents were case tracked. All of them have appropriate care plans, although pre-admission assessments were not done for any of them. Care plans do not include any details regarding the past social history of individual residents. In case of one resident a comprehensive assessment was obtained from her social worker. Risk assessments are not comprehensive and provides very sketchy information regarding the resident. The registered manager needs to ensure that an appropriate risk assessment and planned strategy of intervention is developed for every aspect of risk presented by the resident. In the case of one resident, it is obvious from her assessment that appropriate Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 11 risk assessments should have been done to address specific risks like depression and delusion, and loss of weight. In case of another resident, he has recently developed incontinence problems. The deputy manager explained that he has been referred to the incontinence nurse. At present, they are managing this problem by toileting the resident on an hourly basis. The registered manager needs to ensure that an appropriate incontinence assessment is undertaken, and concrete strategies are put in place to manage this issue. Thereafter, this risk assessment needs to be reviewed and monitored at regular intervals. In another case, recordings in the daily record sheets for the last few weeks constantly indicate that a particular resident has been lacking appetite and not eating well. He has lost weight in the last month. When this issue was discussed with the deputy manager, she said that the District Nurse had been to see him yesterday and the resident would be referred to the dietician. Again, in this case an appropriate risk assessment needs to be drawn up, intervention strategies put in place and the risk assessment monitored at regular intervals. Care plans are being reviewed annually. This again is not appropriate, as resident’s care plans need to be reviewed on a monthly basis. The registered manager needs to ensure that the residents care plans are reviewed by care staff at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. Visits by health and other professionals are recorded. The Optician visits on an annual basis. The deputy manager said that she is currently negotiating for a dentist to visit the care home at regular intervals. Daily records are not kept in an appropriate manner. The daily records of each resident should reflect what the resident has been doing through the day, and any significant developments. In most cases the care workers are recording that the resident has been “fine” or there have been “no problems”. The deputy manager said that she is aware of this problem, and has already made some attempts to address this issue by the means of staff training. At present, information regarding each resident are kept in several files. It is recommended that all pertinent information with regard to each resident is compiled into one file, so that one can get a holistic and comprehensive view about the resident. The service uses a monitored dosage system for the storage and administration of service users medication. The local pharmacist dispenses service users’ prescription checks the home’s medication procedure and provides advice to staff. Examination of service users medication records and stock balance of medication revealed that the medication records of a particular service user, who has moved in recently, did not tally with the actual medication count. The registered manager must ensure that whenever medication is returned, the form should include the name of the service user Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 12 whose medication is being returned, the name of the medication, its strength, signature of the pharmacist and a representative from the care home. The inspector spoke to three residents. One service user said that the staff are “very good” and “caring”. She explained that she does not need any care at the moment, but she is confident that staff members will support her in an appropriate manner, were she to need any help. Another service user said that staff members give her the medication, and she has never had any problems regarding her medication. A resident’s survey was conducted by CSCI. Seven residents completed a survey form. All seven residents said that they “always” receive the care and support they need. Six residents said that staff are “always” available when they need them. One resident has commented that “the girls are very good”, they “never let me down”. Another resident says that staff “are always there”. Regarding Medical support, 3 residents have said that they “always” get the medical support they need. “ resident’s have said that they “usually” get the medical support they need. One resident has said that he/she “sometimes” gets the medical support required and one resident has said that he/she does not need any medical support. Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The routines of daily living and activities made available are flexible and varied to suit resident’s expectations, preferences and capacities. So, the resident’s social, cultural and recreational interests and needs are met. EVIDENCE: Discussion with residents and staff showed that residents exercise choice and make decisions about their lives such as: accessing community facilities independently, how to spend their day, when and where to have their meals etc. There were notes in a resident’s file that said that the resident prefers to dine in her room. The resident has also mentioned this in the service user survey form completed before this inspection. All the residents have their own televisions in their rooms. Some have brought their own televisions into the care home, and others have been provided by the home. Some residents have their own telephone lines. A person of the same gender provides personal support in private, and intimate care where possible and if the resident wishes. Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 14 A tour of the building showed that service users exercise choice as to how to spend their day, either in the communal rooms or in their bedroom, as some residents were watching television and others reading in their bedroom. One resident chooses to spend all of her time in her bedroom. Certain activities are arranged by the home. Some residents visited Sudley House in May 2007. In June-July 2007 residents have visited the Sefton Park – Palm House, tea and dance on a number of occasions. The home maintains an activities book, but not all activities are being recorded systematically. As a result it seems that very few activities are arranged. The deputy manager said that they have lost an activities book, so there is no record of activities that may have been arranged during that period. The deputy manager said that an entertainer visits the home every 2 weeks. The physio also visits the home every 2 weeks to arrange light exercises for the residents. A mobile sweet shop visits the home every 2 weeks. A mobile library also visits the home every three weeks. No records are kept of these activities. Apparently, the staff too arrange inhouse activities like sing alongs, raffles, bingo, cards and reminiscing on a weekly basis, but this again is not being recorded in a systematic manner. Lady’s pampering day is arranged every Tuesday by the staff. It is recommended that activity records are kept more diligently, especially as they have a more able group of residents. A systematic record of all activities arranged by the home should be kept, including details of those service users who participated in specific activities. It is recommended that photographic evidence is kept of activities arranged by the care home. It is also recommended that the registered manager makes appropriate arrangements to consult the residents regarding their choice and preference of activities. The service has an unrestricted visiting policy and service users are able to choose where to see their visitors. A tour of the building showed that many of the service users have brought into the care home some of their furniture to make their personal space more homely with their own belongings. Mealtimes at Sunnyside are flexible and service users are able to choose where and when to have their meals as evidence whilst walking around the building. The dining room is a pleasant room. Service users use the room throughout the day. The meals are well presented and the tables are laid with tablecloths, condiments, serviettes etc. to promote service users choice and alternative meals would be provided. The service has implemented the Safe Food for Better Business to promote the health and safety of service users. There is ongoing training for staff to complete the records required for Safe Food for Better Business. The training includes areas like food allergies, contamination, cleaning effectively, and pest control. However, a record is not kept of alternative food provided to service users. The registered person should record breakfast, snacks, alternative sweet dishes and alternative meals provided to Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 15 service users. Also need to keep a record of the vegetarian meals served by the home. This was also mentioned in the last report. The service would cater for service users requiring a special diet, as evidenced by providing vegetarian meals for service users who prefer this. One resident said that her room is “nice and quiet”. She prefers to stay in her room most of the time and the staff and management “understand that she wants to be on her own”. Her choice is respected. She also commented that the food is “good”. Another resident who has moved in recently commented that the food was “good” and that he prefers to eat downstairs with every one. He however said that he was not aware of any activities being organised by the home. He has “not yet” been informed about this. Another resident spoken to said that the home is “welcoming to visitors”. She chooses to eat in her room and goes out regularly with her family. She said that the food is of “good quality”, and “variations” are available. She has information about various activities arranged by the home, but chooses not to participate in most of them. One staff member spoken to said that the food was “lovely”. They always buy “fresh stuff”, and different tastes are catered to. The residents generally have no complaints regarding the food. She said that the residents enjoyed the visits by the entertainers. Another staff member said that the food is “good” and of a “high quality”. It is “well presented”. The staff member commented that he felt that a good range of activities are made available at the home. It is difficult to find time, but sometimes they do one-to one activities with individual residents. Activities such as reading a book, doing jigsaws and playing cards. A resident’s survey was conducted by CSCI. Seven residents completed the survey forms. All the seven have said that they “always” like the meals provided. One resident said that the food is nice, “I eat regular now, I never used to eat before”. Another resident has commented that “the food is very good”. Three residents say that there are usually activities arranged by the home, which they can participate in. Two service users have said that activities are arranged “sometimes”. Four service users have said that they prefer not to participate in the activities arranged by the home. One service user has commented that “I enjoy resting in my room”. Another resident has said that activities are always arranged “but I choose not to go”. Sunnyside Residential Home DS0000025381.V341453.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): 16,17 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The registered manager has failed to report a serious incident involving two residents to CSCI under regulation 37, thereby not ensuring that residents are safeguarded EVIDENCE: Sunnyside has a complaints procedure, which is displayed in a prominent position. No formal complaints have been received in the past twelve months. Following the recommendation made in the last inspection, the home has now introduced an incident book. One incident has been recorded in April 2007. This incident should have been reported to CSCI under regulation 37 which clearly states that it is the responsibility of the registered person to give notice to the commission of the occurrence of any event in the care home which adversely affects the well-being or safety of any resident. The service users are able to participate in the political process through postal voting or by going to the polling station with a member of staff. Information of Liverpool inter–agency protocol on abuse is available to all staff. All staff members have had appropriate training on abuse related issues. Some residents manage their own finances. Where residents require assistance in managing their personal allowance a record is kept of all Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 17 incoming and outgoings of service users monies. Some resident’s financial records were checked. The records did not tally on two occasions as the home had failed to record the money each of these residents had spent for hair dressing on the day before. It is recommended that the financial records for each resident is kept in a systematic and orderly manner. The accident book was viewed. A resident has had 6 falls since 15/05/07. Her falls have been recorded and reflected in the daily record sheets. It is recommended that a member of the management team sign all accident records, to evidence that they have seen it. The resident’s risk assessment does not reflect her recent falls. In this case the risk assessment needs to be reviewed and updated. Concrete strategies/action plan need to be put in place to manage the resident’s high rate of falls. Most of them are unwitnessed falls. It is recommended that the registered manager analyse and audit the accident data on a quarterly basis. The analysis should involve identifying residents suffering a high rate of falls and investigating the underlying reasons that may be causing it. Following this an appropriate action plan may be formulated to prevent this happening, and reviewed at regular intervals. One staff member spoken to was aware of abuse related issues, but she has never had any reason to report anything. She said she would feel confident to report anything, in case the need arose. Another staff member commented that he is POVA trained, but has never had anything to report. He said that he would directly approach the management if he had any such issues to report. A resident’s survey was conducted by CSCI. Seven residents completed a survey form. When asked whether they knew who they should speak to, if they were not happy about something, six of them have said that they “always” know who they should be speaking to. Four of them have put down the name of the deputy manager. When asked whether they knew how to make a complaint, again six residents have responded in the affirmative. Sunnyside Residential Home DS0000025381.V341453.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): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The physical environment is well maintained to promote a comfortable and homely environment for service users. EVIDENCE: The care home is well maintained both internally and externally. A tour of the building showed that the service users bedrooms are regularly decorated and that renewal of furnishings are made to provide a quality environment for service users. CCTV cameras are used at the main entrance to promote the safety of service users and staff. The care home has a dining room and two lounges on the ground floor with one being designated a smoking lounge. There is a small hairdressing room on Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 19 the first floor. All of the communal rooms are furnished with good quality domestic type furniture. The rooms are bright and well lit and could be used for a variety of purposes as required to meet service users needs. The bedrooms on the upper floors are easily accessed by the passenger lift. Most of the bedrooms have an en-suite and assisted baths and showers are available to promote resident’s choice. Since the last inspection the home has changed a side door to a more secure alarm key-pad system. The home has submitted a plan for an extension to build a conservatory that can be user for resident’s activities. They are awaiting planning permission. Various aids are provided at Sunnyside to promote service user independence and safety such as: call system in every bedroom, grab rails, ramp to front door etc. The quality of the furnishings in the bedrooms is good and many of the bedrooms are furnished with service users own furniture. Service users are given a key to their bedroom if they wish. The care home is centrally heated throughout and service users are able to adjust the heating in their bedroom to meet their requirement. During the tour of the home, it was identified that some tiles in the shower room were broken and would need to be replaced. One resident commented that the home is “cleaned properly”. One staff member commented that there are no problems regarding the laundry or the general cleanliness of the home. A resident’s survey was conducted by CSCI. Seven residents completed a survey form. When asked whether the care home was fresh and clean, all the residents have commented that the care home is “always” fresh and clean. One resident says “its spotless”. Another resident has said that “its spotless, very well run”. Sunnyside Residential Home DS0000025381.V341453.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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service ensures that residents are supported and protected by the home’s recruitment policy and practises. EVIDENCE: The staffing rota and observation of staff on duty showed that the care staff level is sufficient to meet the needs of service users throughout the day and night, as the dependency level of most service users is low. The PreInspection Questionnaire confirms this. The questionnaires and discussion with service users showed that the service users are very happy with the care and cleanliness of the building. Ancillary domestic and catering staff are employed to ensure that service users dietary needs are met and to maintain the cleanliness of the building. The care home was found to be clean and free from malodour on the day of the inspection. Three staff files were viewed. All of them have an appropriate job application form, 2 relevant references and an appropriate CRB check. It is recommended that CRB checks are updated every three years. It is also recommended that all staff members are issued an appropriate job description. The deputy manager informed that all staff members are due to be issued new job contracts as the care home has just changed the employment agency they Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 21 use. This will be done very soon. Of the three files checked, there was no evidence of staff induction on two staff files. In one case, the induction training form has not been fully completed. All subjects have not been covered and the instructor and employee have not signed it at the end. It is recommended that the registered manager ensure that all members of staff receive induction training to National Training Organisation (NTO) specification within 6 weeks of appointment to their posts, including training on the principles of care, safe working practices, the organisation and worker role, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. The deputy manager has just introduced a format that is to be used for staff appraisal and supervision. The format was viewed during the inspection. Of the three files checked, none of the staff members have had any formal appraisal and supervision. It is recommended that the registered manager takes appropriate steps to ensure that care staff receive formal supervision at least 6 times a year. The service is working towards 50 of its staff achieving the NVQ level 2 Care Award. 9 staff members have NVQ level 2. Of them, 2 staff members have enrolled for NVQ level 3. . At present 47 of the staff have got appropriate NVQ qualification. 8 staff members are currently doing their NVQ level 2. Most staff members receive the mandatory training that is essential. There are some gaps, but the deputy manager informed that more training is being planned this year. Following the requirement made during the last inspection, the registered person, the registered manager, the assistant managers and the team leaders have all attended training on dementia care in December 2006. They are planning to arrange this training for all their staff members. As the home caters for some residents with mental health problems, it is recommended that the registered manager considers some appropriate training for staff members on relevant topics. One service user who has moved in recently said that the staff were “alright” and generally helpful. Another service user spoken to said that Staff are “pleasant and well mannered”. She also said that the home has a stable staff group. One staff member spoken to said that she has been working here for more than 10 years and the home feels like “family”. They have a stable staff team, and there are no problems to mention. Appropriate training is made available to the staff team. Another staff member spoken to has been working here for nearly 6 years. He said that he had left in-between to do a course, but came back to work here. He said that he is comfortable working in this atmosphere, where most staff Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 22 members are female. He said he likes the “atmosphere in the home”. He commented that the staff team is stable, and it feels like family. One of his own relatives was placed at this home for several years. He also said that he is currently doing NVQ level 2, but he wants to complete NVQ level 4 after this. The management are “supportive” on this issue. He felt that the home offers a “friendly environment” and the families of the residents placed here are generally “very happy” with the care provided. A resident’s survey was conducted by CSCI. Seven residents completed a survey form. Six of the seven resident’s have said that the staff members listen and act on what they say. One resident has commented that “If I ask for something, I get it”. Another resident has commented that “I accept things as they are”. Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 23 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): 31,32,33,34,35,36,37 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Fire records are not being kept appropriately, so the health, safety and welfare of residents and staff are not being promoted and protected. EVIDENCE: The registered manager was on leave on the day of the inspection. Both the registered manager and assistant managers are accessible to residents and staff. The registered manager is available on site three days a week. The deputy/Assistant manager has completed NVQ level 4 qualification. She is considering going for the registered manager’s post with the approval of the current registered manager and the registered person. The style of management promoted at Sunnyside is open and accepting of suggestions Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 24 from any stakeholder on how the service could be improved. This was evident from the discussions with residents and staff members. The service has a current Public Liability Insurance. The fire records were checked. Fire alarm tests are generally done on a weekly basis. However, only three tests have been done in some months. Fire alarm test records have not been kept systematically in march-april 2007. Emergency lighting tests are not being done. The registered manager needs to ensure that emergency lighting tests are done and appropriately recorded on a monthly basis. Fire drills are not being conducted at present. The deputy manager said that the fire officer who visited the premises said that they are not required to do any fire drills, as their fire alarm is directly connected to the fire service. The fire service can thus respond to it in 5 minutes. However, there is no record of this advise in writing. It is therefore advised that the care home obtain this advise in writing from the fire service. Until such time, fire drills should be organised at regular intervals and records of staff members attending the fire drills should be systematically kept. Day staff should attend fire drills every 6 months, while night staff are required to attend a fire drill every 3 months. Fire risk assessment has been completed. Fire extinguishers, emergency lighting system and fire alarms have all been appropriately serviced. The gas and electricity certificates were seen, and found to be appropriate. The portable electrical equipment testing has also been completed appropriately. The lift has been serviced in august 2006, and will require servicing next month. The home has two wheel chair users, one gets his wheelchair serviced himself from time to time. It is recommended that the care home keep appropriate records to evidence that wheelchairs used by the residents are regularly serviced. Staff meetings are done informally. The deputy manager said that they will sometimes take staff members out for a meal. They occasionally hold formal staff meetings if there are issues to be discussed. However, no records are kept. It is recommended that records of all staff meetings are minuted and systematically kept. Service user meetings are arranged from time to time. The last meeting was held on September 2006. Brief minutes are kept. Fridge and freezer temperatures are not being monitored and recorded. Water temperature records are regularly monitored. A service user survey was done in 2006. The deputy manager said that the format has been changed in 2007. They have already received 5 responses. The registered manager intends to analyse all the responses and collate a report, once she has received all the responses. One resident said that she would not hesitate to approach the registered person or the registered manager in case she had any problems. Another Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 25 resident who has moved in recently was aware of who to approach in case he had a problem. He said he would approach “Salma”, the Assistant Manager. Another service user commented that the home is “clean and well run”. She too felt that the management were “approachable”, and was easily able to identify the deputy manager, as the person she would approach in case she had any problems. One staff member who has been at the home for more than 10 years, said that the management are “approachable”. She said that service user meetings are arranged sometimes, but very few attend. It very difficult to get the residents involved. They generally agree to everything said. Another staff member who has been working at the home for nearly 6 years said that the management are “easy to approach” and in general most service users are satisfied with the services offered. He said that at Sunnyside residents are made to feel “at home” rather than an “institutional approach” . Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 26 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 2 1 1 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 2 2 Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 27 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 OP15 Regulation 13 & 17 Requirement The registered person must ensure that a record is kept of alternative meals provided to service users. This requirement remains outstanding from the last inspection. The registered person must ensure that an accurate record is maintained of all service user medication administered. This requirement remains outstanding from the last inspection. The Statement of purpose needs to be amended to include the following points mentioned in Schedule 1 of the Care Standards Act -The home does not provide nursing care -The fire precautions and associated emergency procedures in the care home -The arrangements made for dealing with reviews of the resident’s care plan The registered manager is required to ensure that each DS0000025381.V341453.R01.S.doc Timescale for action 30/10/07 2. OP9 13 30/09/07 3. OP1 4 15/10/07 4 OP2 5 & 17 15/10/07 Sunnyside Residential Home Version 5.2 Page 28 5 OP3 14 6 OP8 13 7 OP38 37 8 OP38 23 9 OP38 23 10 OP19 23 resident is provided with a written contract/statement of terms and conditions at the point of moving into the home. The registered manager must ensure that no residents move into the home without having his/her needs assessed and been assured that these will be met. The registered manager is required to ensure that an appropriate risk assessment and planned strategy of intervention is developed for every aspect of risk presented by the resident. The risk assessment should be monitored and reviewed at regular intervals. It is the responsibility of the registered person to give notice to the commission of the occurrence of any event in the care home which adversely affects the well-being or safety of any resident. The registered manager needs to ensure that fire alarms are tested every week and appropriate records are systematically kept. Emergency lighting should be tested on a monthly basis and appropriate records kept in a systematic manner. The registered manager is required to ensure that fire drills should be organised at regular intervals and records of staff members attending the fire drills should be systematically kept. Day staff should attend fire drills every 6 months, while night staff are required to attend a fire drill every 3 months. The registered manager needs to ensure that the care home premises are kept in a good state of repair externally and DS0000025381.V341453.R01.S.doc 30/09/07 15/10/07 30/09/07 30/09/07 30/09/07 30/09/07 Sunnyside Residential Home Version 5.2 Page 29 internally. Some tiles in the shower room used by the residents were broken and need to be replaced. 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. Refer to Standard OP3 OP7 OP7 Good Practice Recommendations It is recommended that the registered manager devises a suitable format for recording all pre-admission assessments. It is recommended that resident’s care plans include some details regarding the past social history of individual residents. The registered manager needs to ensure that the residents care plans are reviewed by care staff at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. It is recommended that all pertinent information with regard to each resident is compiled into one file, so that one can get a holistic and comprehensive view about the resident. Daily records are not kept in an appropriate manner. It is recommended that the daily records of each resident should reflect what the resident has been doing through the day, and significant developments if any. It is recommended that the registered manager makes appropriate arrangements to ensure that whenever medication is returned, the form should include the name of the service user whose medication is being returned, the name of the medication, its strength, signature of the pharmacist and a representative from the care home. It is recommended that a systematic record of all day to day activities arranged by the home should be kept, including details of those service users who participated in specific activities. It is also recommended that photographic evidence of activities arranged by the home should be kept. It is recommended that the registered manager makes appropriate arrangements to consult the residents DS0000025381.V341453.R01.S.doc Version 5.2 Page 30 4. OP37 5 OP7 6 OP9 7 OP12 8 OP12 Sunnyside Residential Home 9 10 OP18 OP35 OP38 11 12 13 OP29 OP29 OP38 14 15 OP36 OP30 16 17 18 OP22 OP38 OP32 OP38 regarding their choice and preference of activities. It is recommended that the financial records for each resident is kept in a systematic and orderly manner. It is recommended that the registered manager analyse and audit the accident data on a quarterly basis. The analysis should involve identifying residents suffering a high rate of falls and investigating the underlying reasons that may be causing it. Following this an appropriate action plan may be formulated to prevent this happening, and reviewed at regular intervals. It is recommended that CRB checks for all staff members are updated every three years. It is recommended that all staff members are given an appropriate job description, and a copy of this is kept on their individual staff files. It is recommended that the registered manager ensure that all members of staff receive induction training to National Training Organisation (NTO) specification within 6 weeks of appointment to their posts, including training on the principles of care, safe working practices, the organisation and worker role, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. It is recommended that the registered manager takes appropriate steps to ensure that care staff receive formal supervision at least 6 times a year. As the home caters for some residents with mental health problems, it is recommended that the registered manager considers some appropriate training for staff members on relevant topics. It is recommended that the care home keep appropriate records to evidence that wheelchairs used by the residents are regularly serviced. It is recommended that records of all staff meetings are minuted and systematically kept. It is recommended that fridge and freezer temperatures are monitored on a daily basis and recorded. Sunnyside Residential Home DS0000025381.V341453.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Merseyside Area Office 2nd Floor, Burlington House Crosby Road North Waterloo L22 0LG 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 Residential Home DS0000025381.V341453.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. 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