Inspection on 20/04/06 for Sunrise of Fleet Limited

This inspection was carried out on 20th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sunrise of Fleet Limited 26/09/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Sunrise of Fleet Limited Reminiscence Neighbourhood Church Road Fleet Hampshire GU51 4NB Lead Inspector Mrs Pat Trim Unannounced Inspection 20th April 2006 09:30 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 Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sunrise of Fleet Limited Address Reminiscence Neighbourhood Church Road Fleet Hampshire GU51 4NB 01252 771800 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) Sunrise Operations Fleet Limited Susan Mary Sansby Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28) of places Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Sunrise Reminiscence Neighbourhood is a purpose built care home offering support to 28 older people or older people who have dementia. The home is one of the services offered by Sunrise on the same site and is situated on the third floor of the building. Two lifts are provided to reach the unit. Entry to the home is by coded keypad on the two doors. Bedrooms are single with en suite facilities and for people who wish to share there are suites that have two bedrooms and a shared lounge. The communal areas include a kitchen, lounge and dining room. In addition, the wide corridors are furnished with numerous alcoves and areas where people may sit or use the memorabilia scattered throughout the home. There is a small patio area that service users may use freely and they may also use the ground floor garden that is shared with the sheltered housing scheme. Some people may need staff to go with them to use the ground floor garden. The home is located a few minutes walk from the town centre. Information about current fees was correct at the time of the inspection. A private room costs from £934.50 per week, a studio suite from £1046.50. Those people who are assessed as requiring extra support to that normally provided are required to pay an additional fee of £112.00 per week to reflect the increased staff support needed. There is also a one-time charge payable for the cost of maintaining the communal areas. Additional charges apply for hairdressing, chiropody, newspapers, personal toiletries and ironing. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection for this service, which opened in January 2006. It took one inspector 8 hours to complete. The key standards were assessed by case tracking three residents and talking with six of the nine people currently living in the home. Time was also spent observing staff practice and talking with three of the care staff. Some time was spent reviewing documentation and a partial tour of the premises was carried out. Information was also obtained from comment cards received from residents and relatives. The registered manager for the home had recently resigned so the wellness coordinator and the manager of the domiciliary care service assisted with the inspection. People who live in the Reminiscence Neighbourhood are called ‘residents’ so this term has been used throughout this report. What the service does well: The home has a well-motivated and enthusiastic staff team that support and encourage residents to maintain their life skills and lead fulfilling lives. Residents commented that ‘staff are very kind and respectful. You can live your life as you wish’ and ‘you are able to do what you want here’. ‘They (staff) do a difficult job, but you can be reasonably independent’. Detailed information about individual’s abilities, needs and interests make sure that residents are able to make choices about how they spend their day. For example, staff make sure that residents are able to continue with previous hobbies such as reading or stamp collecting. They also give them opportunities to try out new ones such as baking or flower arranging. A programme of appropriate activities that provide mental stimulation is provided and is monitored to ensure all residents are able to join in if they wish. Residents are also able to join in activities and entertainment provided in the sheltered housing scheme that is on the ground floor of the building. The environment has been thoughtfully designed to provide accommodation that is suitable to meet the needs of residents who have dementia. The home is light and spacious, with plenty of space for people to walk. There are lots of seating areas in the corridors that have been furnished with ‘memorabilia’ that residents may pick up and use. For example, one area has been furnished with a dressing table covered in jewellery and make up, whilst another area has a desk, typewriter and stationary. Sensory pictures have been hung on the walls so residents may spend time touching and feeling the different surfaces. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families are given sufficient information to enable them to make a choice about whether they wish to live in the home. They can also be confident they will only be offered a placement if the service is able to meet the resident’s identified needs. EVIDENCE: All three residents who were case tracked had signed and dated copies of contracts, which, together with the service user’s guide, gave them information about the service they would receive. Information was given about what would not be included in the fee. All three residents case tracked had comprehensive assessments completed prior to admission. The wellness co-ordinator confirmed, as much as possible, people were visited to complete these assessments. She was travelling to Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 9 Kent to complete one on the day of the inspection. If the distance was too great, assessments were completed by phone. Assessments identified any potential risks, such as a history of falls, and what steps would need to be taken to minimise them on admission. Residents were required to provide written information about their health needs from their doctors. Relatives confirmed they had been given information about the service prior to admission and that they had been asked to help in the assessment process. The ‘wellness co-ordinator’ said that visits to the home by the service user prior to admission were not encouraged. This was because it was felt it might be confusing for residents who have dementia. Instead, all admissions have a month’s trial period before the placement is reviewed and made permanent. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans ensure that residents are able to receive the care they need in the way they like it. Risk assessments are used to enable residents to make choices about how they live their lives. Systems are in place that enable staff to monitor health care needs so that residents may be confident their health care needs will be met. EVIDENCE: Three care plans were seen. These gave detailed information and guidance about residents’ needs and how they should be met. They identified what individuals could do for themselves and what they needed help with. They gave clear guidance to enable staff to support residents whilst maintaining their independence. The plans had been signed by residents to demonstrate their involvement, but those spoken with could not remember having discussed their development. An alternative method of demonstrating their involvement could be used to show how their views are represented rather than asking for a signature that they may not remember giving. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 11 Each plan contained evidence that it was regularly reviewed in accordance with the procedure recorded in the service users’ guide. The wellness co-ordinator said that where the resident agreed, families were invited to attend review meetings. Staff were able to describe the support needed by the three residents who were case tracked. They confirmed they got the information they needed from the care plan and from the daily handover and daily records. This was observed being put into practice. For example, a risk assessment had been used to enable staff to help one resident manage his challenging behaviour. A record was being used to identify what had happened immediately before any incident. This had identified that it appeared the behaviour could be the result of his feeling of loss of control over his life. Staff were instructed to ensure he was consulted first about all aspects of his daily life. In practice this meant that staff made sure he was given his paper as soon as it arrived, was asked about what he would like to do and where he wanted to spend time. The risk assessment instructed staff that if the situation escalated, their primary task was to make sure vulnerable service users were safe. A referral to a psychiatrist in old age had been requested to give further advice and support. Care plans identified preferred care routines and these were observed being put into practice. One care plan stated that someone needed two people to help her walk. It also stated that she liked to get up late and that staff should speak gently to her. Two staff were observed walking with her at all times and staff confirmed this was an identified need in her care plan. She was still in bed at 10 a.m. and staff were observed speaking softly to her, asking her if she was ready to get up. Care plans recorded whether residents were happy to receive care from either sex. Staff confirmed their preferences were respected. Residents said they had been asked what they would like to be called by staff. This was recorded on their care plans and staff were aware the information was there. Residents’ health care needs were met. Daily records evidenced that residents had access to health care services such as opticians, chiropodists and dentists. One G.P. visited the home on a weekly basis to see anyone with minor health issues, and residents said they could also see the doctor whenever they wished. The wellness co-ordinator confirmed that residents who lived locally prior to admission could stay with their current doctor. Residents who were new to the area were registered with the local practice, but could request a male or female G.P. Separate health care records were kept on residents’ files of anything relating to health care needs. For example, doctors were asked to complete a file note of any changes to medication or referrals made to specialists. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 12 Residents were also seen regularly by the wellness co-ordinator, who monitored health care needs and ensured all aspects of the residents’ health and social care needs were being met. For example, the wellness co-ordinator said that if staff raised concerns that someone was not eating properly, their weight would be monitored and staff asked to complete a food intake chart, recording whether someone had eaten a whole plateful of food, half or a quarter. Where there were concerns an action plan would be put in place that would include the resident routinely being offered snacks in between meals and deciding whether a referral to a health care specialist should be made. The accident book recorded a number of falls for two residents. This information had been used to trigger a falls review and action had been taken to minimise risk wherever possible. For example, a rug had been removed from one resident’s room as a number of the falls had occurred there. The medication policy and procedure were seen during the inspection. Staff were observed giving out medication in accordance with the procedure. The policy states that only staff who have been trained and assessed may give out medication. Staff spoken with were aware of this and confirmed that only staff who had completed the three-day training gave out medication. All staff who completed the training were then monitored and assessed before being permitted to give medication unsupervised. A written record of this supervision was kept. The wellness co-ordinator said that the majority of medication came in a monitored dosage system. The wellness co-ordinators were responsible for checking the medication into the home. No current resident self medicated, but staff were observed explaining to one resident what his medication was for before asking him whether he wished to take it. It was noted there was no protocol agreed for service users who took medication prescribed as “when required”. This could be an issue where a service user cannot always say they are in pain and staff are required to use their knowledge of the service user to give pain relief. It could also be an issue if someone was prescribed medication to help manage their behaviour. A recommendation to review practice was made. Medication was kept in a locked trolley in a locked room when not in use. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in the outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents may be confident staff will support them so that they are enabled to live their lives in the way they wish. They will be offered choice in all aspects of their daily living and have opportunities and support to participate in activities they enjoy. EVIDENCE: The three residents who were case tracked had life histories, completed by themselves and their families prior to admission. This information was used to ensure activities and experiences were offered that would meet their needs. For example, the record for one resident said that she liked soft toys. During the inspection it was seen that staff made sure she always had one with her. Another enjoyed looking after his stamp collection. His care plan identified that staff should ensure he was able to find his room during the afternoons to do this. This was seen in practice. Several residents had always enjoyed going for walks. Staff were observed throughout the day, accompanying them to the downstairs garden and out for walks. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 14 Residents said they felt able to make choices about how they spent their day. One said she liked going out for walks and that staff were always available to take her out. ‘Staff will take you in a minute’’. Another said you could get up and go to bed when you wanted. She also said ‘your family can visit any time and they can make themselves drinks. You can order them meals that they can have with you’. Comment cards and verbal feedback from relatives confirmed this. One resident said the home was excellent and she felt safe. ‘You can spend time alone if you wish or can join in activities. You can lock your door.’ Care plans identified individual daily routines, such as whether residents liked to bathe or shower, whether they needed help with dressing or shaving. They also identified what residents liked to do for themselves. For example, that someone still liked to choose what they wear and could dress themselves but needed help with buttons. The daily routine of the home is centred on the needs and wishes of residents. A planned weekly programme of short activities has been put in place. This is appropriate for people who have dementia and who may not be able to concentrate for long periods or in large groups. There was lots of opportunity for staff to spend time with individual residents. Staff were observed going for short walks with residents, spending time reading poetry to them during coffee break, arranging hair appointments, accompanying service users to the coffee shop in the sheltered housing scheme and making cakes together in the kitchen area. Residents were encouraged to participate in familiar tasks such as folding towels, setting tables and dusting. The environment is arranged into a number of reminiscence areas where residents may sit and put on makeup or jewellery, write letters or type them, spend time looking after a ‘baby’ or just walk round touching the sensory pictures throughout the unit. The home has a specialist relaxation room called a ‘Snoozelem’. Staff receive training in using this facility. The home does not currently have a pet, but is regularly visited by a dog that lives in the sheltered housing scheme. Several residents said they enjoyed her visits and were seen petting her. The wellness co-ordinator said there were plans to either adopt a dog or arrange for regular visits by one. Staff said that providing mental stimulation for residents was an integral part of their job. They have to complete a dementia training course as part of their personal development programme, which enables them to have insight into the condition and to provide appropriate support. Residents are also able to participate in any entertainment being held in the sheltered housing scheme. For example, several went to a musical afternoon. Information about formal activities is displayed on a notice board in the lounge area. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 15 Care plans recorded any spiritual needs. One resident’s care plan stated that going to church was important to him. Daily records showed that his family were taking him on a regular basis. The wellness co-ordinator said that the home was regularly visited by several ministers and that arrangements would be made for any resident who wished to go to church as part of their support needs. Main meals are provided from a central kitchen situated in the sheltered housing scheme. Staff can also provide light meals and hot drinks from the kitchen in the home. Two comment cards completed on behalf of residents said the food was not always satisfactory, but feedback from residents and two relatives, who were visiting at the time of the inspection, said food was good and plentiful. Residents were observed being shown the menu and the two plated options of main meal. They were then able to select one of the two choices or choose something else. Meal times were very relaxed and unhurried. One resident said she did not want any lunch so staff agreed to make her toast later. She left the table and went for a walk around the home. Staff then offered her a meal again, which this time she accepted. Bowls were used for the main meal where service users had difficulty with flat plates to help them maintain their dignity. The menu plan evidenced a wide range of food choices with hot meals available for lunch and evening meal. The wellness co-ordinator said that special diets were catered for as part of the resident’s needs. No record is made of the meal choice selected by the resident, although staff may monitor the amount of food eaten if there has been a concern identified. A recommendation was made that a record should be kept, to evidence that residents have a balanced diet. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. The robust complaints procedure means that residents can be confident their complaints will be taken seriously by the home and that appropriate action will be taken. The policy and procedure in respect of adult protection, together with the training provided for staff ensures that residents are protected against the risk of abuse. EVIDENCE: The home has a policy and procedure for recording and dealing with complaints. Copies are given to residents and their families on admission. Residents said any concerns they had raised with the management had been resolved satisfactorily and that they were confident they, or their families, could raise concerns and have them addressed. The complaints file contained evidence that issues raised by the families of two residents were being dealt with appropriately. The outcome of the complaints was being monitored by the management of the service and had been referred to in the last monthly report made by the management under regulation 26. The manager of the domiciliary care service was responsible for providing training to all staff in respect of adult protection issues. The training programme comprised showing a video, a group discussion and the completion Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 17 of a questionnaire to demonstrate the member of staff’s understanding of the training. The home had a policy and procedure in relation to the protection of vulnerable adults. This had been reviewed to ensure it complied with the requirements of Hampshire’s adult protection procedure. Three staff on duty at the time of the inspection had completed adult protection training. They demonstrated their awareness of their responsibility in respect of the whistle blowing policy and were confident they would report any alleged abuse. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in the outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The attention paid to the design of the building means that residents are able to live in a clean, comfortable and safe environment that meets their needs. EVIDENCE: The home has been designed to meet the needs of residents who have dementia and has been sensitively furnished. Corridors are light and spacious and provide numerous alcoves with seating so that service users may move freely around the home. Every area is designed to stimulate and provide people with opportunities to revisit stages of their lives. Bedrooms are unfurnished until the resident has decided what belongings they wish to bring. The home then provides any other furniture that is required. Each room has a number and the name of the person living there and, if required, something that helps the person recognise the room. For example, a photo board or a familiar painting. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 19 Residents said they were very satisfied with their rooms and that they enjoyed spending time in them. They were able to lock them and said they felt this gave them privacy and dignity. Every room has en suite facilities and there are two communal bathrooms. There is a lounge, dining room and kitchen. Radiators are covered and all hot water outlets have thermostatic control valves fitted to protect residents from the risk of accidental burns or scalds. There is a small outside area that residents may access freely. This has a seated area and is being used for activities such as potting cuttings. The majority of service users cannot use the main garden independently as it is not secure. Staff regularly accompany them so they can use this facility. Hampshire fire and rescue service (HFRS) required the home to complete a fire risk assessment at the time of registration. This had been done and (HFRS) had confirmed it was satisfactory. The home employs cleaners who work to a cleaning schedule that ensures every bedroom is cleaned thoroughly each week in addition to the daily cleaning. Residents felt the cleaning was completed to a high standard. There were no unpleasant smells at the time of the inspection and the home was clean. Staff were observed taking washing to the laundry room in covered containers. There is a sluice located on the floor above the home for staff to deal with soiled linen. The laundry is off one of the corridors and has a washing machine that has a temperature programme to clean soiled linen. Staff were able to demonstrate their knowledge of the laundry procedure. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably qualified staff are employed in sufficient numbers to ensure the individual needs of residents can be met at all times. Appropriate training is provided to enable staff to develop skills that help them meet the needs of the client group. A robust employment procedure ensures that residents are protected. EVIDENCE: Some relatives had expressed a concern that there might not be sufficient staff to meet the needs of residents when the number living in the home increased. This was discussed with the wellness co-ordinator who explained staffing levels were based on the needs of residents and not the number of people living in the home. She said the management were currently recruiting more staff. This was to ensure there were sufficient staff to support the increase in the number of residents. Relatives also commented on the number of staff have who have left and the high use of agency staff. The wellness co-ordinator said there had been some staff changes following the departure of the registered manager. This had resulted in a higher use of agency staff than the management would have liked. She stated that these staff always worked shifts with the home’s permanent staff. The high use of agency staff had been identified as an issue in the home’s first support visit. The action plan to address the issue included a recruitment drive to employ more staff and the development of the home’s Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 21 bank staff. It also identified the need to establish a rota that had a recognised pattern and the flexibility to increase staffing levels at times of high need. The wellness co-ordinator said normal staffing levels are one lead and two care staff on duty from 7 a.m. till 2.45 p.m., one lead and two care staff on duty from 2.30 to 10.15 p.m. and two waking night staff on duty from 10 p.m. to 7.15 p.m. The staff rota confirmed these are the level of staff currently provided and this was the number of staff seen on duty during the inspection. This is a high level of staff provision for nine residents and enables staff to spend time with residents. A handover period between shifts ensures that information is shared and that staff have the time to read the daily notes. Three staff were case tracked. All had attended interviews, given two written references and completed an application form. All had Criminal Records Bureau and Protection of Vulnerable Adults checks completed prior to working independently with residents. All had, or were completing, the induction and training programme required by the provider. This included an orientation programme. The responsible individual explained that the training programme was being reviewed to ensure it reflected the outcomes required by the Skills for Care organisation. 4 of the 11 staff had achieved National Vocational Qualification (NVQ) 2 or 3. Two of the three staff interviewed had NVQ 3 and one had NVQ 2 and had previous experience of working in residential care. The wellness co-ordinator said more staff were about to start the course. Staff spoken with felt they were well supported by the management and given adequate training. They were expected to progress through the organisation’s training programme. In addition to core training, staff said they could ask for training on specific aspects of care. For example, if they were working with someone who had Parkinson’s disease a short training module would be arranged. Staff felt the training relating to dementia care was particularly good but wanted further opportunities to develop their skills with this client group. They said regular supervision was being given. The training records were inconsistent in recording what training had been completed. The human resources administrator said the management were aware of this and a spreadsheet was being completed to identify what training staff had completed. This was going to be used to monitor training needs and to plan courses. Staff were able to give a summary of each of the care plans belonging to the residents who were case tracked and to describe the help they needed. They said were able to get information through daily handovers, daily records and care plans and felt communication was good. They were expected to contribute to care plans and had the opportunity to discuss issues relating to individual’s care needs. They felt a key part of their role was to provide mental stimulation to service users and said they were expected to spend time with service users, helping them with activities. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 22 Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to monitor the quality of the service and to ensure residents’ needs and wishes are taken into consideration. However, these could be developed further to ensure all residents are able to give feedback about the service they receive. The environment is well monitored and well maintained so that the health and safety of residents is safeguarded. EVIDENCE: Residents and families expressed their disappointment that the registered manager had recently left the service. The wellness co-ordinator was currently managing the service in addition to her normal role. She was responsible for completing pre-admission assessments, writing care plans and managing staff. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 24 The responsible individual said interviews for a replacement had been held and a decision to offer the post to someone would be made shortly. The statement of purpose and service users guide gave information about the quality audit system. As the home has only been running for three months, most of this has not yet been required, but the first quarterly audit had been completed. The report identified what areas were working well and what needed to be done as a matter of urgency. There was an action plan to resolve identified issues. For example, employing and training more staff to prevent the use of agency staff and to develop a bank of staff so that care could be provided more flexibly. The wellness co-ordinator explained there were a number of committees that service users could use to feedback their views of the service. These included a dining committee and an activities committee. However, these are held jointly with the people who live in sheltered housing. It was felt this might not be the best way for residents who live in the home to make their voice heard and consideration should be given to developing additional opportunities. Regular family meetings were held and social activities such as a cheese and wine party. This gives families formal and informal ways of giving their views about the service. The monthly review of the care plan gives both resident and family the opportunity to say how they feel it meets the needs of the resident. The responsible individual said the service uses an outside agency to conduct an annual audit of the group as a whole. The home will be included in this audit. Regulation 26 visits are also used to enable residents and their families to give feed back to a member of the management about the service. They also provide an opportunity to monitor service provision. The manager for the domiciliary care service explained that residents may ask the home to hold sums of money for them. This is kept in the domiciliary care service safe, rather than in the home. This is not a problem, provided residents are always able to get money when they need it. Written records of transactions are kept and residents asked to sign for the receipt of any money. The management of the service is expected to make random checks of balances. The maintenance engineer for the home confirmed all equipment and utilities were regularly serviced. A number of service contracts were seen during the inspection. These included invoices for the recent servicing of the lifts, assisted baths, fire alarm and extinguishers. The maintenance engineer for the home explained he completed visual checks of all small electrical appliances on a monthly basis and completed a health and safety check for each room. A company had been employed to complete the fire risk assessment for the home. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 25 The fire logbook was seen. Weekly tests were completed for fire alarms and fire doors. Fire drills were carried out at least monthly. The maintenance engineer said he explained the fire procedure to each new member of staff on their first day. Staff confirmed they received this induction. Staff completed mandatory training such as food hygiene, first aid, moving and handling before being required to carry out any tasks that related to it. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 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 X 3 X 3 X X 3 Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP12 OP15 OP33 Good Practice Recommendations That there is an agreed protocol for administering “when required” medication to service users who are unable to ask for it to ensure pain relief is consistently given. That as the numbers of residents increase, consideration is given to providing entertainment within the home. That a record is kept to demonstrate that each service user is receiving a wholesome and balanced diet. That consideration is given into developing ways service users can have their own forums for giving feedback about the service they receive. Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sunrise of Fleet Limited DS0000066526.V289692.R01.S.doc Version 5.1 Page 29 - 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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