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 30th August 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.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.V310090.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 Mrs Lesley Ann Chaplin Care Home 26 Category(ies) of Dementia - over 65 years of age (26) registration, with number of places Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 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 may 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.V310090.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. The current fees are as follows: A single en-suite room costs from £1,050 - £1169 per week. A companion suite costs from £973 - £1169 per person, per week. These fees include a charge of £42.50 per day to cover the cost of three hours personal care. Any additional personal care that may be required is charged at £16 per hour, to reflect the increased staff support needed. The charges above do not include bedroom furniture. Residents are expected to bring their own furniture. If this is not possible, furniture can be provided but this is then billed to the resident or their representative. 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. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of Sunrise of Westbourne, Reminiscence Neighbourhood since registration with the Commission in February 2006. This unannounced inspection took place over 9 hours on the 30th August 2006. 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. Pre-inspection information had been completed and submitted before the inspection. In addition, the Commission received nine completed comment cards from residents and relatives. 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. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the interaction between residents and staff, as well as talking with nine residents, the registered manager, a member of the Wellness Team, the Maintenance Co-ordinator, some of the staff on duty during the day and three visitors. The Inspector also spoke briefly with two Sunrise Area Managers who were present during the day, carrying out a routine quality assurance audit. The daily routine was observed during the inspection, including the provision of meals and the dispensing of medication. Concerns were identified about the medication systems in the Reminiscence Neighbourhood. The Commission for Social Care Inspection Pharmacy Inspector visited on 8th September to assess medication systems and the outcome is included in this report. Detailed findings from the pharmacy inspection are available in a separate visit letter. What the service does well:
Comprehensive assessments identifying care and support needs are carried out jointly by the manager and a member of the Wellness Team prior to admission. A care plan is developed and implemented following assessment. Relatives are encouraged to contribute to the development of care plans by providing important background information, social history etc. 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 before making a decision about whether or not to move in. A months trial period is available to help ensure the placement will be successful.
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 7 Care plans ensure that staff have the information they need to meet the needs of residents. Risk assessments are in place and appropriate steps are taken to minimise any risks identified. Health needs are also well met, with evidence of good support from community health professionals. 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 seen to knock and wait for a response, before entering. Personal care is carried out discreetly. All residents appeared well-presented and wearing jewellery, hearing aids, spectacles etc where appropriate. Residents have opportunities to be on their own if they wish, allowing privacy for any visitors or personal care needs. One resident commented, Sometimes I want peace and quiet, so I go to my room. A planned weekly programme of activities is in place and residents are also able to participate in any entertainment being held in the Assisted Living Neighbourhood. Information about planned activities is displayed throughout the Community. There is plenty of opportunity for staff to spend time “one-to-one” with individual residents, for instance chatting with them, spending time reading newspapers to them and accompanying residents for walks in the garden. Residents are encouraged to participate in familiar tasks such as folding linen and setting tables. A relative commented, One of the strengths of Sunrise is its interest in keeping residents active and entertained. My relative has enjoyed lots of outings and as a result is looking very well. The environment is arranged so that residents may walk and find sitting areas, as well as different reminiscence areas where, for instance, they may try on makeup or jewellery, 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 pet, a cat called Eric. Several residents commented on how much they enjoyed Eric’s company and liked to stroke him and help look after him. The Reminiscence Neighbourhood has an open visiting policy in place. Visitors commented, ”I have always been welcomed and made to feel at home. The whole atmosphere is friendly and relaxed.” “Visitors are always made to feel very much at home. Residents confirm they feel able to make choices about how they spend their day, e.g. where they go, what they wear, what they eat and what they choose to do. One resident said, Sometimes I like to join in with things, but sometimes I want to be in my own room, - they dont seem to mind. I feel safe here. I have my own front door and I can lock it if I want to. A visitor commented, “My relative did not feel like getting dressed one day, so just
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 8 spent the day in pyjamas and dressing gown. No-one minded. They said it was the residents’ home and they could do as they liked.” Hot meals are cooked in the main kitchen in the community and transferred to the Reminiscence Neighbourhood in hot trolleys. The menu evidenced a wide range of food choices including cooked breakfasts and three course meals available 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, I enjoy my meals, we have lovely food here, I had never eaten so well before coming here. A robust complaints policy and procedure ensures that residents can be confident their complaints will be taken seriously and that appropriate action will be taken wherever necessary. A visitor confirmed, The manager is always approachable and willing to talk about any concerns that might arise. 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. The attention paid to the design and layout of the building means that residents are able to live in comfortable and safe surroundings that meet their needs. The Reminiscence Neighbourhood also has a comfortable lounge, dining room and Snoezelen (multi-sensory room), which is available for relaxation and pleasure purposes. In addition, the wide corridors are furnished with numerous alcoves and areas where people may sit or use the memorabilia available throughout the home. Maintenance records show that continual work is carried out to keep the home and grounds in good condition. The home is clean with no unpleasant odours, making life for all more pleasurable. Residents felt the cleaning was completed to a high standard. One resident commented, “My room is kept spotlessly clean.” Suitably qualified staff are employed in sufficient numbers to ensure the individual needs of residents can be met at all times. Residents spoke positively about staff. They make me happy here. The people here are very kind to me and very patient. Relatives commented, Staff are always very knowledgeable about my relatives care needs and are happy to chat about what has taken place since my last visit.” The home has a robust employment policy and procedure in place, based upon equal opportunities. Three staff files were examined. All had the required documentation in place. Training is currently in the process of revision and will shortly be introduced as Sunrise University training, which will offer a greater depth of training to staff. A new staff induction programme is also starting shortly.
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 9 The Reminiscence Neighbourhood provides a supportive, caring and relaxed environment where residents feel comfortable and secure. Mrs Chaplin 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. A visitor said, “The manager is excellent. She always makes a point of speaking to all visitors and always knows about my relative’s care. I am always kept well informed about care needs and they telephone me immediately if there are any changes or things I need to know. Regular audits are carried out by Sunrise Senior Living Limited, to ensure good standards are maintained. Mrs Chaplin regularly speaks with all residents and visitors to the home to obtain their views. She is also hoping to send out formal quality assurance questionnaires shortly to residents, relatives and representatives, in order to obtain further feedback about the service provided and where improvements may be made. 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. 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. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place and fire drills and staff fire training are taking place at the required intervals. What has improved since the last inspection? What they could do better:
When examination of medication and Medication Administration Records, (MAR) took place, it was evident that some residents had not been receiving
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 10 their medicines because the home was out of stock. A book is available for care staff to communicate any problems with medication to the Wellness Team but there was little evidence to demonstrate these concerns had been followed up. The Commission for Social Care Inspection Pharmacist Inspector subsequently carried out an inspection on 08/09/06 and made requirements and recommendations, which are included at the end of this report. The Reminiscence Neighbourhood also has a comfortable lounge, dining room and Snoezelen (multi-sensory room), which is available for relaxation and pleasure purposes. However, this is not much used at the present time and more training may be needed for staff to gain confidence in encouraging the use of this facility. There is a furnished outside terrace area that service users may safely access at any time. It was noted that, in contrast to the attention paid to detail elsewhere in the home, the plants on the terrace were in a very poor condition and most had died. The Care Homes Regulations 2001 require that the registered persons will provide adequate furniture, bedding and other furnishings in bedrooms. These should be in place, unless the resident chooses to bring items of his or her own furniture etc. Comments from residents and visitors demonstrated that they had been told they must supply their own furniture. If this is not possible, furniture can be provided but the cost is then billed to the resident or their representative in due course. Mrs Chaplin demonstrated a good knowledge of the operation of the service. However, communication systems within the community need developing so that some aspects of the registered managers role can be improved. For instance, the Wellness Team has overall responsibility for residents’ health needs, including medication. Although staff are reporting difficulties with medication, including running out of some items, Mrs Chaplin is unable to intervene in the role of the Wellness Team. This may mean that Mrs Chaplin is not always able to fully implement her role and responsibilities as registered manager. This matter needs to be resolved. 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 Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 11 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.V310090.R01.S.doc Version 5.2 Page 12 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 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. 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 by the home are offered places there. The home assures prospective residents in writing that their needs can be met. EVIDENCE: Individual care records are kept for each resident and three of these were examined. All showed that, prior to moving to the home, care needs had been fully assessed. Written assurance is given where the home feels that care needs can be met. Comprehensive assessments identifying care and support needs are carried out jointly by the manager and a member of the Wellness Team. Prospective residents or their representatives are also invited to complete a Residents
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 13 Profile so that they can provide information they feel happy to share about their life story, family background and daily living preferences. With consent, a doctor’s report is also requested so that relevant health information can be incorporated into the care plan. 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 before making a decision about whether or not to move in. A months trial period is available to help ensure the placement will be successful. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 14 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 this outcome area is adequate. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. The Reminiscence Neighbourhood has a care planning system in place, which ensures that staff have the information they need to meet the needs of residents. Health needs are also well met, with evidence of good support from community health professionals. The home has good written procedures for medication but systems for ordering medicines and following up any problems with them need improving so that they are given as prescribed and resident’s health and wellbeing is not put at risk. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 15 EVIDENCE: All three of the care plans examined flow from the assessments made earlier and are clearly set out, informative about the needs of each resident and how staff are to meet these needs. Relatives are encouraged to contribute to the development of care plans by providing important background information, social history etc. Evidence was seen to show that at least once a month, care plans are reviewed and updated where necessary. Care plans recorded how to approach individual residents, e.g., “Needs a calm, gentle approach, ensuring tasks are always explained before beginning them.” Care plans also identified preferred care routines and these were observed being put into practice during the inspection. It is helpful to staff to know how much personal care residents can do for themselves, e.g., “Can wash own face and hands.” One care plan stated that a resident became very anxious about any loud noises and staff should be with him during any fire alarm test. Staff were observed with this resident during a planned test of the fire alarm system, which took place during the inspection. Records demonstrate that residents have access to health professionals, such as GPs, district nurses, chiropodists, opticians, etc and attend for hospital appointments, etc. Risk assessments are in place and appropriate steps are taken to minimise any risks identified. The Wellness Team is responsible for the ordering, safe administration and disposal of medicines received in the care home. A member of the Wellness Team demonstrated that the home has a good policy and procedures in place for dealing with medication. Lead Care Managers undergo three days training, a written test and further assessment of competence before being able to dispense medicines to residents. No residents are currently self-medicating but the home has a form to assess their ability and any risks if they wish to do this. However, when examination of medication and Medication Administration Records (MAR) took place, it was evident that some residents had not been receiving their medicines because the home was out of stock. A carry forward balance is sometimes recorded to provide a recent stock balance but this is not consistent. It was therefore not always possible to check if medicines had been given as prescribed. A book is available for care staff to communicate any problems with medication to the Wellness Team but there was little evidence to demonstrate these concerns had been followed up. The Commission for Social Care Inspection Pharmacist Inspector subsequently carried out an inspection on 08/09/06 and made requirements and recommendations, which are included at the end of this report.
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 16 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 seen to knock and wait for a response, before entering. Personal care is carried out discreetly. All residents appeared well-presented and wearing jewellery, hearing aids, spectacles etc where appropriate. Residents have opportunities to be on their own if they wish, allowing privacy for any visitors or personal care needs. One resident commented, Sometimes I want peace and quiet, so I go to my room. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 17 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 this outcome area is excellent. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. A range of activities, entertainment and opportunities for outings provides variation and interest for residents. Open visiting arrangements are in place, so residents are able to maintain contact with visitors as they wish. Residents are encouraged to choose their own lifestyle within the home and their individual preferences and routines are respected. A balanced and varied selection of food is served, which meets residents’ tastes and dietary needs within pleasant surroundings. This means meals are a pleasant experience for all. 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, as demonstrated during the inspection, some activities also occur spontaneously to fit in with
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 18 the needs and wishes of residents. Residents are also able to participate in any entertainment being held in the Assisted Living Neighbourhood. Information about planned activities is displayed throughout the Community. On the day of inspection these included a garden stroll, coffee and newspapers, hand/eye co-ordination games, a Smoothie Social and then a DVD with popcorn. The Smoothie Social was not well attended, with several residents commenting that they would prefer cups of tea and cakes rather than smoothies. Regular outings are arranged to local beauty spots and places of interest. Two residents enjoyed an outing on the morning of the inspection. Several residents talked of their pleasure in taking part in such outings, including a recent trip on a boat around Poole Harbour. There is plenty of opportunity for staff to spend time “one-to-one” with individual residents. Staff were observed chatting with residents, spending time reading newspapers to them and accompanying residents for walks in the garden. Residents are encouraged to participate in familiar tasks such as folding linen and setting tables. One resident said, “I like to help with the dusting. This is a big place and a lot to keep clean, so I like to help out.” A relative commented, One of the strengths of Sunrise is its interest in keeping residents active and entertained. My relative has enjoyed lots of outings and as a result is looking very well. 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 home has a pet, a cat called Eric. Several residents commented on how much they enjoyed Eric’s company and liked to stroke him and help look after him. Care plans record any individual spiritual needs. The manager confirmed that clergy from different denominations regularly 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. The Reminiscence Neighbourhood has an open visiting policy in place. Comment cards and verbal feedback from relatives confirmed this: - “Visitors are always made to feel very much at home.” ”I have always been welcomed and made to feel at home. The whole atmosphere is friendly and relaxed.” “I have nothing but praise for the home.” One resident commented, “Your family can visit any time and they can have a meal with you.” On the day of inspection a number of visitors, including children, were observed visiting the Reminiscence Neighbourhood and spending time with residents.
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 19 Care plans record whether residents are happy to receive care from either male and/or female staff. Staff confirm their preferences are always respected. 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 they go, what they wear, what they eat and what they choose to do. One resident said, Sometimes I like to join in with things, but sometimes I want to be in my own room, - they dont seem to mind. I feel safe here. I have my own front door and I can lock it if I want to. I used to be afraid about going outside, but now someone comes with me. I cant remember her name, but she is very nice to me. I enjoy going out with her. A visitor commented, “My relative did not feel like getting dressed one day, so just spent the day in pyjamas and dressing gown. No-one minded. They said it was the residents’ home and they could do as they liked.” Hot meals are cooked in the main kitchen in the community and transferred to the Reminiscence Neighbourhood in heated trolleys. Good food hygiene practice was observed, including testing the temperature of food on arrival at the Reminiscence Neighbourhood. 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 very relaxed and unhurried with staff offering discreet assistance where required. Bowls are used for the main meal where residents have difficulty with the usual plates, to help them maintain their dignity and independence. The menu evidenced a wide range of food choices including cooked breakfasts and three course meals available 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. Lunch on the day of inspection was as follows: Vegetable and barley broth, or avocado and mozzarella salad. This was followed by roast pork with applesauce or vegetarian cottage pie, with Boulangere potatoes, carrots and broccoli. Then a choice of sweets, including spotted Dick and custard, gâteau, pastries and ice cream. Residents commented, I enjoy my meals, we have lovely food here, I had never eaten so well before coming here. Relatives commented, both on the day and in comment cards, The food is very good. I have had meals here and the standard is well above average. My relative has a good appetite and has been enjoying cooked breakfasts. The meals are excellent and offer plenty of choice.
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 20 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 this outcome area is good. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. A robust complaints policy and procedure ensures that residents can be confident their complaints will be taken seriously and that appropriate action will be taken wherever necessary. 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/or their representatives on admission. Residents and visitors confirmed that any concerns they had raised with the manager had been resolved satisfactorily and that they were confident they could raise concerns and have them addressed. The complaints file demonstrated that two complaints have been received and both had been dealt with appropriately. One resident said, “If I was worried about something, I would tell the head lady here and she would put it right, she is very good like that.” A visitor
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 21 confirmed, The manager is always approachable and willing to talk about any concerns that might arise. The home has an Adult Protection policy in place to protect residents from possible abuse. The Department of Health No Secrets document is also available to staff. All staff are given training in Adult Protection issues. A member of staff later confirmed the Adult Protection training was helpful in identifying the different forms of abuse and how to deal with any suspicion of abuse, to ensure residents are safe within the home. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 22 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, 20, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. The attention paid to the design and layout of the building means that residents are able to live in comfortable and safe surroundings that meet their needs. However, bedrooms should be available furnished and at present, residents have to bring all their own bedroom furniture or pay for that provided by the home. Maintenance records show that continual work is carried out to keep the home and grounds in good condition. The home is clean with no unpleasant odours, making life for all more pleasurable. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 23 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. 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 join in under staff supervision. The Reminiscence Neighbourhood also has a comfortable lounge, dining room and Snoezelen (multi-sensory room), which is available for relaxation and pleasure purposes. However, this is not much used at the present time and more training may be needed for staff to gain confidence in encouraging the use of this facility. The wide corridors are furnished with numerous alcoves and areas where people may sit or use the memorabilia available throughout the home. For example, residents may try on different items of clothing, makeup or jewellery, or sit 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. Residents may also use the ground floor garden that is shared with the Assisted Living Neighbourhood, but may need staff assistance to do so. It was noted that, in contrast to the attention paid to detail elsewhere in the home, the plants on the terrace were in a very poor condition and most had died. 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. A resident commented, I have a lovely room. I have everything I need here. One of the comment cards received mentioned that it was “a shock” to learn that furniture was not provided, especially in view of the high level of fees being charged. Another commented on not being informed about having to provide furniture until the very last minute before admission was due to take place. A further telephone call was received from another relative saying, “I think this is a cheek. I was not told about this (providing own furniture) until it was too late to argue about it. I could find no mention of it in any of the Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 24 literature I was given beforehand.” The manager confirmed that the fees payable do not include the provision of furniture. Residents are expected to bring their own furniture. However, if this is not possible, furniture can be provided but the cost is 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. These should be in place, unless the resident chooses to bring items of his or her own furniture etc. The Maintenance Co-ordinator ensures that cleaning staff work to a schedule that ensures every bedroom is cleaned thoroughly each week in addition to the daily cleaning, emptying of waste bins etc. Residents felt the cleaning was completed to a high standard. One resident commented, “My room is kept spotlessly clean.” There were no unpleasant smells at the time of the inspection and the home was found to be clean throughout. Suitable facilities and procedures are in place in respect of laundry and the disposal of clinical waste. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 25 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 this outcome area is good. This judgement has been made using available evidence including a visit to Sunrise of Westbourne, Reminiscence Neighbourhood. Staff are employed in sufficient numbers to ensure the individual needs of residents can be met at all times. The home is working towards the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. An improved training programme is being introduced, which will enable staff to develop skills to help them meet the needs of the residents. A robust employment procedure ensures that residents are protected. EVIDENCE: The weekly staffing roster shows sufficient staff on duty throughout the day, including two wakeful staff at night. On the day 7 a.m. -- 3 3 a.m. -- 9 9 p.m. -- 7 of inspection, p.m. 4 p.m. 3 a.m. 2 staffing was as follows: Care Managers, including 1 Agency staff member. Care Managers. wakeful Care Managers. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 26 This is a good level of staff provision for the current 13 residents and enables staff to spend time with them. 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. There is currently a total of 13 staff employed in the Reminiscence Neighbourhood, but there are still some staff vacancies. Agency staff are used wherever necessary. The same Agency is used, supplying staff that have worked in the home previously. At present, agency staff are being used for one shift each day and four night shifts each week. Agency staff are always on duty with an experienced Care Manager. Mrs Chaplin is actively seeking to recruit additional staff so that there will not be a need to employ Agency staff. Residents spoke positively about staff. They make me happy here. The people here are very kind to me and very patient. Relatives commented, Staff are always very knowledgeable about my relatives care needs and are happy to chat about what has taken place since my last visit. I think the staff are very good and very caring. They are always there when needed. It is recommended that a minimum ratio of 50 per cent 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, none of the care managers has achieved NVQ level 2, but two members of staff have attained NVQ level 3. Mrs Chaplin says it is the intention of Sunrise Senior Living Limited to offer NVQ level 2 training to all staff, as part of the improved training package soon to be made available. The home has a robust employment policy and procedure in place, based upon equal opportunities. Three staff files were examined. All had completed an application form and attended interviews. Two written references were on file. Where staff were coming from abroad, evidence was available to demonstrate their right to work in this country. All staff had Criminal Records Bureau and Protection of Vulnerable Adults checks completed prior to working independently with residents. Sunrise Senior Living Limited has an induction programme in place in all its establishments. This is known as the Star Gate Orientation Programme and staff then move to the training and development programme, the 5 Star Training Programme. Training is currently in the process of revision and will shortly be introduced as Sunrise University training, which will offer a greater depth of training to staff. Discussion was held with the manager about the changes that are taking place with induction and ongoing training. This will include all of the mandatory training required by staff. Sunrise Senior Living Limited will also be introducing a new induction programme linked to the Skills for Care Common Induction Standards.
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 27 One member of staff said, “I enjoyed the training on dementia. It was interesting and I learned a lot. It made me look at things differently.” A relative commented, When residents get upset or aggressive sometimes, staff are always calm and deal with everything very smoothly. They are obviously well trained. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 28 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, 36 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. Mrs Chaplin demonstrated a good knowledge of the operation of the service, ensuring the needs of residents are well met. An internal auditing system is in place and the home is also planning to formally review its performance and seek the views of residents, staff and relatives to ensure the home is run in the best interests of residents. Residents are assured of sound management of their financial interests. Some staff are not being supervised at the recommended intervals, to ensure good practice. There are good arrangements for managing health and safety in the home, to ensure that the well-being of residents is promoted and protected.
Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 29 EVIDENCE: The Reminiscence Neighbourhood provides a supportive, caring and relaxed environment where residents feel comfortable and secure. Mrs Chaplin 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. A member of staff commented, Our manager is very supportive. She can be very firm when she needs to be but she will also help out when necessary and is very good with residents. A visitor said, “The manager is excellent. She always makes a point of speaking to all visitors and always knows about my relative’s care. I am always kept well informed about care needs and they telephone me immediately if there are any changes or things I need to know. Communication systems within the community need developing so that some aspects of the registered managers role can be improved. For instance, the Wellness Team has overall responsibility for residents’ health needs, including medication. Although staff are reporting difficulties with medication, including running out of some items, Mrs Chaplin is unable to intervene in the role of the Wellness Team. This may mean that Mrs Chaplin is not always able to fully implement her role and responsibilities as registered manager. This matter needs to be resolved. Discussions with staff show that they are well aware of their duties and responsibilities and feel the work they do is important and valued. Staff commented: “Everyone working here feels part of a team. We are all part of a team and work well together, supporting each other.” “ I enjoy my work. This is a very good place to work. They want you to be the best.” Regular audits are carried out by Sunrise Senior Living Limited, to ensure good standards are maintained. Two Sunrise Area Managers were carrying out an unannounced quality assurance audit at the time of the inspection. Mrs Chaplin regularly speaks with all residents and visitors to the home to obtain their views. She is also hoping to send out formal quality assurance questionnaires shortly to residents, relatives and representatives, in order to obtain further feedback about the service provided and where improvements may be made. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 30 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. 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. Care staff should receive formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. The three staff files examined evidenced that staff supervision is taking place, but not always at the recommended intervals. 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 confirmed that regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Records show that routine checks of emergency lighting, fire fighting equipment and the fire warning system are carried out at appropriate intervals and staff were able to confirm this. The records demonstrate that fire drills and staff fire training are taking place at the required intervals. The staff on duty confirmed that they had received fire training. A disaster contingency plan is also in place to ensure the safety of all in the home. The Maintenance Co-ordinator also demonstrated that regular health and safety checks and maintenance of equipment is carried out to ensure the safety of the home. Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 3 2 X X X 1 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 2 X 3 X 3 2 X 3 Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 32 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. 1 Standard OP9 Regulation 13 Requirement The Registered Person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: a) Having a system to ensure that resident’s medicines do not run out of stock. b) Reviewing the timing of doses with the GP where necessary so that medicines are given as prescribed. c) Following up medicines not supplied with the pharmacy and /or GP to check if the resident’s medication has been changed. d) Recording the dose given if a choice is prescribed. The registered persons shall provide in bedrooms, adequate furniture, bedding and other furnishings and equipment suitable to the needs of residents, unless residents choose to part or fully furnish their own bedrooms. The registered person must
DS0000066196.V310090.R01.S.doc Timescale for action 12/10/06 2 OP24 16(2)(c) 31/12/06 3 OP36 18(2) 31/12/06
Page 33 Sunrise of Westbourne, Reminiscence Neighbourhood Version 5.2 ensure that staff are appropriately supervised at the recommended intervals. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP9 OP20 Good Practice Recommendations It is recommended that there should be an “in house” system for monitoring the audit trail with the medication records to check that medicines are given as prescribed. It is recommended that the person responsible for recording medicines returned for disposal should sign the record. 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. It is recommended that more care be taken with the displays of plants on the terrace, to ensure they provide something pleasant for residents to look at and enjoy. It is recommended that a minimum ratio of 50 per cent trained members of care staff at NVQ level 2 or equivalent, be achieved. It is recommended that communication systems within the management structure of the community should be improved so that the registered manager is enabled to fully discharge her management responsibilities in the Reminiscence Neighbourhood. 4 5 6 OP20 OP28 OP31 Sunrise of Westbourne, Reminiscence Neighbourhood DS0000066196.V310090.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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