Inspection on 14/08/07 for Sunrise of Westbourne, Reminiscence Neighbourhood

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Westbourne,... 30/08/06

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

CARE HOMES FOR OLDER PEOPLE Sunrise of Westbourne, Reminiscence Neighbourhood 16-18 Poole Road Westbourne Bournemouth Dorset BH4 9DR Lead Inspector Marjorie Richards Key Unannounced Inspection 09:30 14th August 2007 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 Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.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. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunrise of Westbourne, Reminiscence Neighbourhood 16-18 Poole Road Westbourne Bournemouth Dorset BH4 9DR 01202 760966 01202 762130 westbourne.rc@sunriseseniorliving.com Address 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 Westbourne Limited Susan Shelly Knights Care Home 26 Category(ies) of Dementia - over 65 years of age (26) registration, with number of places Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2006 Brief Description of the Service: Sunrise Senior Living Limited was developed in the United States of America and now operates across the United States and in Canada, Germany and the United Kingdom. The Sunrise establishments are known as ‘Sunrise Senior Living Communities’. The Community operating at Westbourne in Bournemouth provides two types of service within the same establishment, an ‘Assisted Living Neighbourhood’ and a ‘Reminiscence Neighbourhood’. The Assisted Living Neighbourhood is located on the ground, first and second floors and offers people a choice of rented accommodation only or rented accommodation together with domiciliary care services. The Reminiscence Neighbourhood, the subject of this report, is situated on the third floor. This is a Care Home providing care for people with dementia or memory impairment. There are stairways or two lifts available to access the Reminiscence Neighbourhood and entry to the home is by coded keypad on both doors. The entire Community is easily accessible to those with mobility difficulties, or in wheelchairs. Bedrooms are single with en suite facilities and for those who wish to share there are companion suites that have two bedrooms with a shared bathroom and kitchenette. The communal areas include a kitchen, lounge, dining room and Snoezelen (multi-sensory 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 an outside terrace area that service users may use freely and they may also use the ground floor garden that is shared with the Assisted Living Neighbourhood. Residents usually need staff to accompany them when using the ground floor garden. The home is staffed to provide 24-hour personal care. Laundering of personal clothing, bed linen etc is carried out on the premises. All meals are prepared and cooked within the Community. A choice of menu is offered at meal times, with a variety of alternatives available to suit individual taste and preference. A range of activities is available every day and there are regular opportunities for outings. The organisational structure includes a Wellness Co-ordinator, responsible for Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 5 issues regarding residents’ health and medication and a Maintenance Coordinator, responsible for health and safety issues around the building, (including fire safety) and cleanliness. The Community is situated close to the local amenities of Westbourne and within a short journey of Bournemouth town centre and the seafront. There is plenty of on-site car parking. Mrs Knights provided details of the current fees, as at the time of inspection. A companion suite costs from £728 per person, per week. The price for a single en-suite room ranges up to £938 per week. These fees are for accommodation only. A charge of £45 per day is made to cover the cost of providing the basic personal care package. Any additional personal care that may be required is charged at a further £17 or £34 per day, to reflect the increased staff support needed. If still further care input is needed, a price will be negotiated. There is also a one-time charge payable on admission towards the cost of maintaining the communal areas. Additional charges apply for hairdressing, chiropody, newspapers, personal toiletries etc. A copy of the home’s inspection report is always available to anyone wishing to read it, upon request. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choosing a care home .aspx Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9.5 hours on the 14th August 2007. The purpose of this inspection was to review all of the key National Minimum Standards and to ensure that the residents living in the Reminiscence Neighbourhood are safe and properly cared for and to look at progress in meeting the requirements and recommendations made following the previous inspection. The Commission for Social Care Inspection’s Pharmacist Inspector also came to the home to inspect the handling and administration of medicines. The Annual Quality Assurance Assessment (AQAA) form had been completed by Mrs Knights and provided to the Commission for Social Care Inspection in advance of the inspection. Recent legislation has made it a legal requirement for all registered services for adults to complete an AQAA every year. The completed assessment is one of the ways in which the Commission for Social Care Inspection will assess how well the service is delivering good outcomes for the people using it. For the purposes of this report, people who live in the Reminiscence Neighbourhood are referred to as residents, as this is the term generally used within the Community. On the day of inspection twenty-one residents were accommodated, including two currently in hospital. A tour of the premises took place and records and related documentation were examined, including the care records for four residents. Time was spent observing the daily routine during the inspection and the interaction between residents and staff, as well as talking with eight residents, the registered manager, the executive director and some members of staff on duty. The Inspectors were made to feel welcome in the home throughout the inspection. What the service does well: A thorough admissions procedure allows prospective residents to make informed decisions about admission to the home. Comprehensive assessments prior to admission identify care needs and any potential risks. Wherever possible, a 24-hour calendar is completed, detailing the prospective resident’s normal routine over a 24-hour period, in order to help the resident settle into the Reminiscence Neighbourhood more easily on admission. The Reminiscence Neighbourhood provides clean and well-maintained surroundings where the personal, health and social care needs of residents are Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 7 met. Each resident has a care plan, which clearly sets out how staff are to meet individual care needs. Care plans are updated as necessary to reflect any changing needs. The home has procedures for handling and administering residents’ medication and a good medication policy is in place. The Neighbourhood uses monitored dosage blister packs and Medicine Administration Record (MAR) charts printed by the pharmacy, to help ensure medicines are given as prescribed. Medicines are taken round the home safely. A planned programme of activities is in place and regular outings are arranged to local beauty spots and places of interest. Several residents talked of their pleasure in taking part in such outings. One resident said, “I like going on the trips, it is so nice to get out and about. We go out to lots of places.” Regular events are also arranged each month in conjunction with the Assisted Living Neighbourhood. The staff treat residents with respect and provide encouragement for them to pursue their own lifestyles, wherever possible, and to make choices about their daily lives. Residents are supported to maintain contact with family and friends, enabling people living in the home to continue to enjoy relationships that are meaningful to them. Residents say that their visitors are made welcome. Residents have opportunities to be on their own if they wish, allowing privacy for any visitors or personal care needs. One resident commented, “I can lock my front door if I want to.” (Special locks are fitted that can be accessed from outside in case of emergency.) A wide range of food choices is available, including cooked breakfasts and three course meals at lunchtime and evenings. Special diets are catered for as well as individual taste and preference. Drinks and snacks, including finger foods, are available 24 hours a day. Residents commented, The food is very tasty. I like soup and cakes best. On the whole, the food is very good. I enjoy most of it. My favourite meal here is roast beef with Yorkshire pudding and roast potatoes. Accommodation in the Reminiscence Neighbourhood is of a high standard. There is a comfortable lounge, dining room and Snoezelen (multi-sensory room which is available for relaxation and pleasure purposes.) The wide corridors are furnished with alcoves and areas where people may sit or use the memorabilia available throughout the Neighbourhood. Bedrooms are single and all have ensuite facilities. For those who wish to share there are companion suites that have two bedrooms with a shared bathroom and kitchenette. Bedrooms more than meet the minimum size requirement of 12 sq. metres. One resident commented, I like to show people my home, I think it is lovely. To ensure the safety of residents, the Reminiscence Neighbourhood has systems in place to ensure that staff are only recruited after a rigorous screening process and they are given training to ensure they can do their jobs Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 8 well. Residents and staff agree that the Neighbourhood is a good place in which to live and work. Residents say, I like to look after myself as much as possible, but they help me whenever I ask. They are always there if you need some assistance.” Since the last inspection a new manager has been appointed and she has the support of an Executive Manager on site. Mrs Knights has an “Open door” policy so that she is available to residents, relatives and staff whenever needed. As part of its Quality Assurance programme, Gallup conducts independent annual surveys. These involve residents, relatives and staff, in order to obtain feedback about the service provided and where improvements may be made. There are also a number of committees where residents can feedback their views of the service and make their voices heard. In order to protect residents, the Reminiscence Neighbourhood prefers to have no involvement in personal finances. The home pays for services such as chiropody and hairdressing and this amount is then invoiced for payment. What has improved since the last inspection? What they could do better: The home needs to improve systems to ensure that directions for administering medication are kept up to date. It is recommended that staff receive further training in the use of the Snoezelen multi-sensory room, so that residents may be encouraged to make more use of this facility. The Reminiscence Neighbourhood must work to achieve the recommended minimum ratio of 50 per cent trained members of care staff at NVQ level 2 or equivalent. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 9 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. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 10 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 Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable in this care home. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. Information provided about the Reminiscence Neighbourhood and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met are offered places there. EVIDENCE: Individual care records are kept for each resident and four of these were examined. All showed that, prior to moving to the home, care needs had been fully assessed. Comprehensive assessments identifying care and support needs are carried out jointly, usually by the manager and a member of the Wellness Team. These pre-admission assessments identify any potential risks, such as a history of falls, and the steps needed to minimise them on admission. Wherever possible, a 24-hour calendar is completed, detailing the prospective resident’s normal routine over a 24-hour period, including when they choose to go to Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 12 bed, what they prefer to wear in bed, when they like to get up, their favourite meals etc. This information will help the resident settle into the Reminiscence Neighbourhood more easily on admission. Prospective residents or their representatives are also invited to complete a Residents Profile so that they can provide information they feel happy to share about their life story, family background and social preferences. With consent, a doctor’s report is also requested so that relevant health information can be incorporated into the care plan. The full care plan, called an Individual Service Plan, (ISP) is developed and implemented following assessment. Prospective residents and their relatives or representatives are invited to visit the Reminiscence Neighbourhood, to look around, perhaps enjoy a meal, meet with the manager, staff and other residents and ask any questions before making a decision about whether or not to move in. At this point, discussions are held about whether the prospective resident wishes to fully or partially furnish their own room or use the furniture provided by the home. A months trial period is available to help ensure the placement will be successful. Copies of the Statement of Purpose and Service User Guide are provided to each resident and their relatives or representative. Once the assessment has been completed, a letter of confirmation is written to assure the prospective resident (or their relatives or representative) that the home can meet their needs. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. Residents are treated with respect and their personal care needs are met, with the home also ensuring they have access to a range of healthcare services to meet all assessed needs. The home has procedures for handling and administering residents’ medication as prescribed but some aspects of record keeping need improving to safeguard their wellbeing. EVIDENCE: Care records for four residents were examined and each contained a full range of assessments, including a social history. The care plans identify each resident’s needs and the actions required by staff to meet these needs. Observation as well as discussion with staff and residents confirms that care plans reflect the actual care provided. Mrs Knights says that, wherever possible, the Individual Service Plan is agreed by the resident themselves, or by a relative or representative. This was evidenced on only one of the care plans examined. The other three are for Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 14 residents admitted in June and August and still awaiting the signatures of the resident or their representative. Care plans are clearly set out, informative about the needs of each resident and how staff are to meet these needs. They identify preferred care routines and indicate the tasks that residents can do for themselves, e.g., “Give….the flannel to wash own face and hands.” Care plans also demonstrate that regular reviews are taking place and care plans are updated as necessary to reflect any changing needs. Risk assessments are in place and appropriate steps are taken to minimise any risks identified. Good daily records are written by both day and night staff to evidence the care being provided. These show that residents have access to General Practitioners, district nurses, dentists, chiropodists, opticians etc and attend appointments as necessary. This was later confirmed in discussion with residents and staff. The home has a good medication policy and trained staff administer medicines. No residents are self-medicating but the home has procedures for assessing the risks if they wish to do this. The home uses a monitored dosage system and Medicine Administration Record (MAR) charts printed by the pharmacy. Medicine allergies or “none known” were not recorded with one person’s medication record although the information was in their file. Medicines that are handwritten on the MAR chart are countersigned as checked by a second member of staff to safeguard residents but a change in dose for one medicine on the previous month’s MAR chart had not been updated on the current one. Staff record medicines received administered and returned for disposal. There is a good audit trail and the quantity of medicine remaining of those checked agreed with the records indicating that they are given as prescribed. The Wellness team monitor medication records and handling but this did not include checking the audit trail to see if it agreed with the records. There were a lot of gaps in the records for two months at about the same time that reviews of staff medication practice lapsed. There was a concern about the delay in addressing this but in July the number was much lower following action taken. Staff were observed throughout the inspection to be treating residents with courtesy, patience, kindness and respect. Bedroom and toilet doors have locks fitted and staff were observed knocking and waiting for a response, before entering. Personal care is carried out discreetly. All residents appear wellpresented and wearing jewellery, spectacles etc where appropriate. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 15 Care plans evidence that each resident’s dignity is considered in all tasks. E.g., “Carer to ask if ….wishes food cut up and if so, to be cut up in the kitchen and taken to the table.” Residents have opportunities to be on their own if they wish, allowing privacy for any visitors or personal care needs. One resident commented, “I can lock my front door if I want to.” Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. The home is flexible in its approach to the provision of activities and meals, enabling residents to retain control over their lives wherever possible. EVIDENCE: The daily routine of the home is centred on the needs and wishes of residents. A planned weekly programme of activities is in place and some activities also occur spontaneously to fit in with the needs and wishes of residents. Mrs Knights says that the local Alzheimer’s Society has recently commenced running a monthly gardening club, utilising the raised beds in the garden outside. Information about planned activities is displayed throughout the Community. On the day of inspection these included an Extend gentle exercise to music session, a fresh fruit social, nail and hand care, reminiscence and a Cognitive Quiz. Residents are also encouraged to participate in familiar tasks such as folding towels or setting tables. Regular outings are arranged to local beauty spots and places of interest. A group of residents enjoyed an outing on the morning of the inspection, despite Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 17 very poor weather. Several residents talked afterwards of their pleasure in taking part in such outings. One resident said, “I like going on the trips, it is so nice to get out and about. We go out to lots of places.” Regular events are also arranged each month in conjunction with the Assisted Living Neighbourhood. In August, these include a boat trip to Wareham and Poole Harbour, a Holy Communion service, a tea dance and entertainment such as a magician, piano player, singers and sing-a-longs. Staff were observed sitting with residents and spending time talking with them. A group of residents enjoyed participating in a quiz during the morning. The member of staff also used the questions as a means of engaging residents in conversation and in reminiscence. Residents are encouraged to participate in familiar tasks such as folding linen and setting tables. One resident commented, “I like to help with laying the tables, I enjoy helping out. This is my job.” The environment is arranged so that residents may walk and find sitting areas, as well as different reminiscence areas where they may try on clothing, makeup or jewellery, spend time looking after a ‘baby’ or sit at a desk and use a typewriter or write letters. As residents walk around the Reminiscence Neighbourhood, the walls have sensory pictures and wall hangings for them to touch and enjoy. The home has a multi-sensory room called a “Snoezelen” which is available for relaxation and pleasure purposes. The Reminiscence Neighbourhood has a pet cat called Eric. Residents say they enjoy Eric’s company and like to stroke him or have him sit on their laps. Mrs Knights says she will consider accepting individual resident’s own small pets and this can be discussed as part of the admission process. Care plans record any individual spiritual needs. Mrs Knights confirmed that clergy from different denominations visit the Reminiscence Neighbourhood and suitable arrangements would be made for any resident wishing to attend church. This would include an escort if necessary as part of the care provided. A monthly inter-denominational Christian communion service is also held within the Community. In addition, two people regularly visit to give readings from the Bible. The Reminiscence Neighbourhood has an open visiting policy in place. Residents commented that their visitors are made to feel welcome. One resident said, “I have visitors at any time. You can order meals for them and they can eat with you.” Care plans record whether residents are happy to receive care from either male and/or female staff. Residents are asked how they wish to be addressed by staff. This information is also recorded in care plans. Residents confirm they feel able to make choices about how they spend their day, e.g., where Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 18 they go, what they wear, what they eat and what they choose to do. One resident said, “This is my place and I can do what I want.” Another resident commented, “I like going out for walks. I like to see the garden.” Hot meals are cooked in the main kitchen in the Community and transferred to the Reminiscence Neighbourhood in hot trolleys. Good food hygiene practice was observed, including testing the temperature of food on arrival at the Reminiscence Neighbourhood. The dining room is attractively presented and permits easy access for those residents in wheelchairs. Residents were observed being shown the menu and having it explained to them where necessary. The two main options at mealtimes are plated up so that residents can actually see what is on offer. They are then able to select one of the two choices or choose something else if they prefer, for example, from a range of omelettes, jacket potatoes with toppings and a variety of salads. Meal times are relaxed and unhurried with staff offering discreet assistance where required. Some staff were also seen sitting with residents and eating a meal, adding to the social aspect of the occasion. A wide range of food choices is available, including cooked breakfasts and three course meals at lunchtime and evenings. The weekly menu is displayed in the Neighbourhood and daily menus are also available on each dining table. Special diets are catered for as well as individual taste and preference. Drinks and snacks, including finger foods, are available 24 hours a day. Lunch on the day of inspection was as follows: • Yellow split pea soup, or melon and mandarin cocktail. • Poached salmon with a cream and mushroom sauce, or cheese and tomato tart, with new potatoes, carrots and green beans. • Choice of sweets, including chocolate and blackcurrant sponge, fresh fruit salad with cream, various ice creams. Residents commented, The food is very tasty. I enjoyed my dinner, whatever it was tasted very nice. I like soup and cakes best. On the whole, the food is very good. I enjoy most of it. My favourite meal here is roast beef with Yorkshire pudding and roast potatoes. The meat is always very nice. I enjoy my meals. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. The systems in place provide residents with the confidence that their complaints will be listened to and acted upon and they are protected from possible abuse. EVIDENCE: The home has a policy and procedure for recording and dealing with complaints. Copies are given to residents and/or their representatives on admission. Residents confirmed that any concerns they had raised with the manager had been resolved satisfactorily. One resident said (pointing to the manager), “If I was worried about something, I would go straight to the top.” Another commented, The person in charge puts things right. When I told her that I lost something she found it for me. The complaints file demonstrated that eight complaints have been received since the last inspection. One is currently being investigated and the others have been dealt with appropriately. A whistle-blowing policy is also in place. The home has an Adult Protection policy in order to protect residents from possible abuse. The Department of Health No Secrets document is also Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 20 available to staff. All staff are given training in Adult Protection issues within their induction. There is a flow chart on view in Mrs Knight’s office to assist staff in identifying the correct procedure to follow, along with relevant telephone numbers if needed. Since the last inspection, two safeguarding vulnerable adults referrals have been received. These were investigated by Bournemouth Borough Council social workers and found to be unsubstantiated. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. Environmental standards are high, providing residents with comfortable, clean and well-maintained surroundings in which to live. EVIDENCE: The Reminiscence Neighbourhood is situated on the third floor of the Community and is accessed by means of stairways or two lifts. To ensure the safety of residents, access is only by coded keypad at both entrances to the Reminiscence Neighbourhood. Following some recent concerns about security, further improvements to procedures have been instigated. The communal areas include a well-equipped kitchen, which is used for the preparation of snacks and making drinks, as well as activities such as cake baking, where residents can safely participate with staff supervision. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 22 The Reminiscence Neighbourhood also has a comfortable lounge, dining room and Snoezelen (multi-sensory room which is available for relaxation and pleasure purposes.) However, Mrs Knights reports that the Snoezelen is still hardly ever used at the present time. The wide corridors are furnished with numerous alcoves and areas where people may sit or use the memorabilia available throughout the Neighbourhood. For example, residents may try on different items of clothing, makeup or jewellery, or sit at a workbench with tools, or perhaps at a desk and use a typewriter or write letters. The environment is carefully arranged so that as residents walk around the Reminiscence Neighbourhood, the walls have sensory pictures and wall hangings for them to touch and enjoy. There is a furnished outside terrace area that service users may safely access at any time. Furniture and cushions are rain proof and quickly dry after a shower. Residents may also use the ground floor garden that is shared with the Assisted Living Neighbourhood, but are accompanied by staff when doing so. One resident says that she helps to look after the plants on the terrace. Each bedroom displays a number and the name of the person living there. To further assist with identification, on the wall outside every bedroom is a memory box containing items of significance for each occupant. Bedrooms are single and all have ensuite facilities. For those who wish to share there are companion suites that have two bedrooms with a shared bathroom and kitchenette. Bedrooms more than meet the minimum size requirement of 12 sq. metres. All electric sockets are placed at a height suitable for disabled residents. Lights in ensuite facilities, toilets and bathrooms turn on automatically on entry. Adjustable beds are provided for two residents with additional care needs. Special door locks are fitted so that residents may lock their doors but the lock automatically disengages if the door handle is turned to exit the room. Staff can gain entry from the outside with a key in an emergency. Bedrooms are comfortable and personalised in varying degrees by their occupants. One resident proudly showed a collection of soft toys and another commented, I like to show people my home, I think it is lovely. At the last inspection, the manager confirmed that the fees payable did not include the provision of furniture. Residents were expected to provide their own furniture and if this was not possible, furniture could be provided by Sunrise, but the cost was then billed to the resident or their representative in due course. The Care Homes Regulations 2001 require that the registered persons will provide adequate furniture, bedding and other furnishings in the care home. Mrs Knights confirmed that furniture is now provided within the Reminiscence Neighbourhood, but the resident may choose bring their own to furnish or partially furnish their room if they wish. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 23 The Maintenance Co-ordinator ensures that cleaning staff work to a schedule that ensures every bedroom is cleaned thoroughly on a weekly rota, in addition to the daily tidying and emptying of waste bins etc. A tour of the Reminiscence Neighbourhood demonstrated that the cleaning is completed to a good standard. En-suite facilities are also well maintained. There were no unpleasant smells at the time of the inspection and the home was found to be clean throughout. All bed linen etc is laundered in the Community’s main laundry. Residents’ personal clothing is washed within the small laundry in the Reminiscence Neighbourhood. Mrs Knights said that she had instigated improvements in the laundry service since the last inspection. Items of clothing now have name labels. Each resident’s clothing is washed separately, not only for hygiene reasons but also to help ensure that personal clothing is kept together and does not get mislaid. This process was witnessed during the inspection. Suitable facilities and procedures are in place for the disposal of clinical waste. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 24 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 Sunrise of Westbourne, Reminiscence Neighbourhood. The Reminiscence Neighbourhood has systems in place to ensure that staff are only recruited after a rigorous screening process and then receive suitable training to make sure they are able to meet the needs of the residents. EVIDENCE: The weekly staffing roster shows five care managers on duty in the mornings and four in the afternoons, including a senior care manager on both shifts. There are two wakeful care managers at night. Twenty-one residents are currently accommodated, although two are currently in hospital. Mrs Knights says that she feels she has sufficient staff on duty at the present time, but will always increase staffing levels whenever necessary, to ensure the needs of residents are always met. Some Agency staff are working in the Reminiscence Neighbourhood. Before employing any such staff on their first shift, Mrs Knights receives a data sheet from the Agency with a photograph of the employee and written confirmation that references have been provided and Criminal Records Bureau and POVAfirst checks are in place. This was evidenced during the inspection. Wherever possible, the same Agency staff are used to provide some continuity for residents. Agency staff are always on duty with an experienced Care Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 25 Manager. Mrs Knights is hoping to recruit more permanent staff so that there will not be a need to employ Agency staff. There is a system in place to ensure that residents (and their relatives and representatives) know the name of the designated Care Manager, who has special responsibility for their care. A confrontation flared involving two residents during the inspection. Staff responded very quickly to intervene and diffuse the situation, handling matters calmly and efficiently and spending time with both residents afterwards to ensure no ill-effects. Residents spoke positively about staff. I like to look after myself as much as possible, but they help me whenever I ask. They are always there if you need some assistance. If I call out they come very quickly. It is recommended that a minimum ratio of 50 trained members of care staff at National Vocational Qualification (NVQ) level 2, or equivalent, is achieved to help ensure that residents are in safe hands. At present, three of the care managers have achieved NVQ level 2 and two care managers have attained NVQ level 3. Mrs Knights says she is expecting more staff to complete NVQ training in the coming year. The home has an employment policy and procedure in place, based upon equal opportunities. Each applicant completes an application form and attends for two interviews. The first is a group interview and the second a personal interview with two members of the Sunrise team. Evaluation forms are completed after both interviews. Two staff files were examined and these showed that the required documentation had been obtained prior to staff commencing work, such as Criminal Records Bureau and Protection of Vulnerable Adults checks, two written references, proof of identity etc. However, on one file the reference provided by the previous employer had not actually been written by the person in charge. This was discussed with Mrs Knights and she explained that procedures for obtaining references had now been improved to ensure this should not happen in future. The second file, for a more recently employed member of staff, contained all of the required documentation, including suitable references. Before commencing work with residents, new employees undertake three weeks induction training, which includes Protection Of Vulnerable Adults, moving and handling, dementia care, fire safety procedures and activities. Since the last inspection, Sunrise Senior Living Limited has also introduced a new induction programme linked to the Skills for Care Common Induction Standards. After commencing employment, staff work through this programme and their line manager signs off the different elements when they are felt to be competent. Mrs Knights also discusses progress at regular supervision sessions. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 26 Staff also have opportunities to undertake further training and copies of certificates are retained on file. Mrs Knights says she is hoping arrange more external training in specialised subjects during the coming year. This will include moving and handling, challenging behaviour and dementia care. It is hoped that lead care managers will be attending a three-day course in dementia care shortly and this programme will then continue with similar training for the care managers. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. The management arrangements at Sunrise of Westbourne, Reminiscence Neighbourhood and the quality assurance system now in place, ensures that the residents live in a home that is well managed and the service provided meets their needs. EVIDENCE: Since the last inspection a new manager has been appointed. Mrs Knights has recently achieved registration with the Commission. She has the support of an Executive Manager on site and also attends meetings with other registered managers within the region, to share any problems and discuss new ideas etc. Mrs Knights has recently completed a five-day Leadership in Dementia Care course. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 28 On the day of inspection, the Reminiscence Neighbourhood demonstrated that it provides a supportive and caring environment where residents feel comfortable and at ease. Residents commented, I am staying in this place until I can go back to my own home. I am not sure where this is, but it is very nice. It will do until I go home. The people here are all very nice, I like their company. Mrs Knights says she feels it is important to remain open and accessible to residents, visitors and staff and therefore has an “Open door” policy so that she is available whenever needed. This was demonstrated throughout the inspection, with staff seeking advice and several residents dropping in for a chat. Communication systems within the Community have been improved since the last inspection. There is now greater liaison between the registered manager, the Wellness Team, Housekeeping and Maintenance etc, so Mrs Knights is able to better implement her role and responsibilities as registered manager. Staff say they feel the work they do is important and valued. Staff commented: “I enjoy my work. I feel I am part of a team and we get on well together.” “I enjoy my job. I have done a lot of training since I came here.” As part of its Quality Assurance programme, Gallup conducts independent annual surveys. These involve residents, relatives and staff, in order to obtain feedback about the service provided and where improvements may be made. Mrs Knights says that she also obtains regular feedback through her conversations with residents and relatives on a daily basis. Staff meetings are held, generally monthly, so that staff also have the opportunity to express their views. In the Annual Quality Assurance Assessment, Mrs Knights says she is hoping to organise a monthly support meeting for relatives. Mrs Knights explains that there are a number of committees where residents can feedback their views of the service and make their voices heard. There are currently regular meetings regarding activities and the dining service, but these are for the whole Community. Mrs Knights is looking to implement changes, so that both Neighbourhoods have their own meetings to discuss these topics. She feels this will encourage greater participation from residents in the Reminiscence Neighbourhood and their relatives. In order to protect residents, the home prefers to have no involvement in personal finances. Therefore, all residents who are unable or have no wish to handle their own affairs have a relative or other representative to deal with their finances wherever possible. The home pays for services such as chiropody and hairdressing and keeps a record of what is owed. This amount is then invoiced to relatives or representatives for payment. Mrs Knights Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 29 confirmed that she is holding no monies or valuables for residents in the Reminiscence Neighbourhood at the present time. In the Annual Quality Assurance Assessment, Mrs Knights confirms that all staff members receive supervision every two months. Appraisals are also carried out after three months and then annually. Those records viewed confirm that staff are receiving formal supervision every two months, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. all substances that could be potentially hazardous to health are handled and stored safely and restrictors are fitted to windows. All radiators have low surface temperatures, to minimise the risks to residents from hot surfaces. Hot water temperatures are thermostatically controlled to prevent any risk from scalding. (These were tested during the inspection and found to be within safe limits.) Staff demonstrated an awareness of health and safety issues. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of service users and staff. The Maintenance Co-ordinator makes sure that regular maintenance and routine checks of the fire warning system, emergency lighting and fire fighting equipment are taking place. The staff on duty confirm that they have received fire training. A fire risk assessment is in place to ensure the safety of all within the Community. The Maintenance Co-ordinator is also responsible for ensuring that regular health and safety checks are carried out to ensure the safety of the Reminiscence Neighbourhood. Records evidence that equipment used within the Neighbourhood, such as lifts, hoists and assisted baths undergoes regular servicing to ensure it is safe to use. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 30 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X X X 4 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement The home must ensure that there are robust systems in place to ensure that records of medicine allergies and directions for administering medicines are kept up to date to safeguard residents. Timescale for action 01/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard 1. OP20 Good Practice Recommendations It is recommended that staff receive further training in the use of the Snoezelen multi-sensory room, so that residents may be encouraged to make more use of this facility. Repeated. It is recommended that a minimum ratio of 50 per cent trained members of care staff at NVQ level 2 or equivalent, be achieved. Repeated. 2. OP28 Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V343597.R01.S.doc Version 5.2 Page 33 - 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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