Inspection on 16/02/09 for Sunrise Operations Bassett Ltd

This inspection was carried out on 16th February 2009.

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

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 Operations Bassett Ltd 13/08/09

Sunrise Operations Bassett Ltd 29/02/08

Sunrise Operations Bassett Ltd 27/03/07

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Sunrise Operations Bassett Ltd 111 Burgess Road Southampton Hampshire SO16 7AG Lead Inspector Janet Ktomi Unannounced Inspection 16th February 2009 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sunrise Operations Bassett Ltd DS0000068064.V374026.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 Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunrise Operations Bassett Ltd Address 111 Burgess Road Southampton Hampshire SO16 7AG 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) 02380 706050 02380 706051 Sunrise Operations Bassett Ltd Manager post vacant Care Home 29 Category(ies) of Dementia (0) registration, with number of places Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 29. Date of last inspection 29th February 2008 Brief Description of the Service: Sunrise Operations Bassett Ltd is a residential home registered to provided care and accommodation for up to twenty-nine older people with Dementia. The home is situated on the second floor of a large complex, the lower three floors (terrace, ground and first) being a registered care home with nursing for up to seventy-five older people. Bedrooms are predominately single although some twin rooms are available. Open plan communal rooms and a relaxation room are provided, as is an enclosed roof terrace. Access to the unit is achievable via the stairs or alternatively the passenger lift and the facilities of the entire ‘community’ are available to the ‘reminiscence’ clients, although this is reliant on sufficient staff being available to accompany people outside of the ‘reminiscence’ environment. The home is owned by Sunrise Operations Bassett Ltd and at the time of the inspection visit did not have a registered manager. The fees for accommodation and care at Sunrise Operations Bassett Ltd, ‘reminiscence’ service ranges from £1008 per week to £1256 per week. There may be additional care costs dependant on assessed needs. Additional charges are payable for hairdressing, chiropody newspapers and some other services. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 16th February 2009. Information received shortly after the inspection visit is also considered. All core standards and a number of additional standards were assessed. The visit to the home was undertaken by two inspectors and lasted approximately six hours. The inspectors were able to spend time with the person in charge and staff on duty and were provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the service completed an Annual Quality Assurance Questionnaire (AQAA), information from which is included in this report. Comment cards were sent to the home for distribution to people who live at the home. Two comment cards were received from people who live at the home and two responses were received staff who work at the home. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspectors were able to meet with and talk to people who live at the home and staff members on duty. What the service does well: The homes environment is specifically designed and purpose built and provides a high quality of individual accommodation and communal areas. Fixtures and furniture are of a high quality and provide people with pleasant living accommodation. The home has a pre-admission assessment that should ensure that only people whose needs can be met will be admitted to the home. People’s rights to dignity and privacy are respected. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 6 A range of activities is provided throughout the day. Staff undertake a thorough induction. People were positive about the care staff. The home has internal audit systems and procedures that helps them to evaluate the service that they provide to people. What has improved since the last inspection? What they could do better: The following requirements were made as a result of the inspection visit. Care plans do not identify all of people’s individual and current needs and do not satisfactorily inform the delivery of care to people, to ensure that all their needs are met. Risk assessments are either not present, or if present, have not been reviewed and do not clearly relate to people’s current needs. A requirement is made that everyone living at the home must have a care plan and risk assessments must be carried out that clearly identify their current needs and how these are to be met. Care plans and risk assessments must be agreed with the person whose plan of care it is and must be reviewed at least every month and when needs change. The home must ensure that accurate records are completed in respect of care provided and where additional recording is required such as weight, food/fluid or bowel action charts these must be fully completed, so that people’s health and well-being is monitored and changing needs are responded to. The home must ensure that it responds promptly to incidents and ensures the safety of people living at the home. Staff must undertake all mandatory and other relevant specialist training to ensure that they are able to meet the needs of people living at the home. Other areas that the home could improve are also detailed in the relevant outcome areas in the following report. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 7 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 Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 8 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 Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 9 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, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are assessed prior to moving into the home. However it was not evident that this satisfactorily informs the meeting of people’s needs when they move into the home. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: The homes admission procedure was detailed in the AQAA and pre-admission assessments were viewed for people admitted shortly before the inspection visit. The inspectors discussed the admission process with the person in charge, staff and comments from surveys completed by people who live at the home and staff are also considered. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 10 The person in charge explained the homes admission procedure that was also detailed in the AQAA. The AQAA detailed the homes admission procedure stating that all prospective residents and their families are invited to visit the home prior to their stay. The AQAA stated that the home always undertakes a preadmission assessment and that relatives are requested to complete a resident profile providing additional information about the person including hobbies and past social interests and life history information. The AQAA stated that the home also gets a report from the persons GP before they move in. The AQAA also stated that the person or their relatives are provided with information about the home. Comment cards were received from two people who live at the home and both stated that they had received a contract and enough information about the home in order to make the decision as to whether to move in or not. Pre-admission assessments were seen in the service users folders viewed. The home’s assessment tool covers relevant areas necessary for the home to decide if it is able to meet a prospective persons needs. The assessment tool is a tick box with limited space for additional information or for the identification of specific needs and how these may be met by the home. Copies of GP reports were seen in service files as stated in the AQAA. Also seen in care files were forms completed by relatives providing additional information about social history and interests. Care plans viewed did not contain all risk assessments and management guidelines necessary to ensure the safety of people living at the home indicating that the admission assessment is not informing the meeting of people’s needs satisfactorily. This is further evidence in respect of this in the next section of the report. A staff member identified that the service could do better ‘by putting results of assessments into action as soon as possible and to pass on/out information for all relevant staff. People’s needs on admission to the home may therefore not be met either at the time of admission or during their stay at the home. The homes AQAA identified that short stay or respite accommodation could be provided and the same pre-admission assessment and procedures would be followed. The home does not provide dedicated accommodation for, intermediate care or specialised facilities for rehabilitation. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments do not identify all of people’s individual current needs and do not inform the delivery of responsive care to people, failing to meet some needs and protecting them from identified risks. People are treated with respect and their dignity is generally maintained however the unpleasant aroma in at least one bedroom does not evidence that the persons needs are being met or their dignity maintained. Medication was generally stored securely however it may not have been stored at the correct temperatures placing people at risk. The records of medication administration do not reflect that people are receiving their medication safely, as prescribed on every occasion. EVIDENCE: Four care plans were viewed, one for a new person and the other’s for people Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 12 who had been at the home for a longer time. The inspector discussed with staff, visitors and people who live at the home how care needs were met. The arrangements for the storage and administration of medication and related records were viewed and discussed with the person in charge. Comment cards from people who live at the home stated that they always (1) and usually (1) received the care and support they required. They also stated that they always (2) received the medical care they need. Care plans, risk assessments and related records were viewed for four people. Care plans did not contain evidence that care plans or risk assessments had been reviewed on a monthly basis. Care plans appeared to be reviewed six monthly. One plan stated that it had been produced on the 27/08/08 with a review date set for 08/03/09. Another written on the 10/02/09 with a planned review date of the 10/08/09, the third written on the 08/01/09 to be reviewed on the 08/06/09. Some had additional hand written entries where needs had changed. However it was clear that these people had complex and changing needs which needed to be reviewed regularly. There was also no record in care plans or risk assessments that the person whose plan it was had been involved in the plans formation or agreed to the care plan. There were inconsistencies noted on care plans that did not correspond with the care that had been given as recorded on daily records. This showed that the planning of care did not reflect people’s needs. One person’s manual handling risk assessment stating that the person will need to be assisted using a hoist or standaid. There was no information about the size or type of sling that should be used with the hoist. The care plan stated that the person could weight bear with the assistance of two staff but care staff should use the hoist to limit the risk of injury. Daily records recorded that the person had been assisted to have a shower and had ‘not needed the hoist – weight bearing well’. People are therefore at risk if their needs are not made clear putting this person at risk of falls if an inappropriate technique of moving and handling is used. They may not be encouraged to use the mobility they have and therefore become more dependant. Without clear guidance and a consistent approach in terms of people’s care they are at risk. Three of the four care plans viewed contained evidence within daily records that the people had behaviours which could include aggressive behaviour to staff or other service users, however the care plans did not contain specific information or guidance as to how these behaviours should be responded to and people safely supported and protected from harm. The commission had received notifications about incidents involving one of the people whose care plan was viewed. The care plan did not state that the person could be aggressive and provided no guidance to staff for managing behaviours; the care plan stated that ‘X needs assistance when confused and to give time to re orientate’. Similar statements were included on the other two care plans viewed where people had challenging behaviour. The home was recording Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 13 incidents however the charts for one of the three people with challenging behaviours could not be located. There was no evidence that the incident sheets had been used to identify reasons for the behaviours or plan how future incidents could be avoided or managed more appropriately. There were also concerns that other information was not being used to alter care plans to ensure that peoples needs would be met. One person’s care plan stated that the person was known to have a good appetite and no special diet was required. The person had been weighed in August 2008 on admission to the home and not again until February 2009. The person had lost 4.6 Kg and this had been recorded on a wellness assessment completed in February 2009, which also recorded that the person eating habits were very small. There was no indication of what action the home was planning on take to address the weight loss or ensure the person received a satisfactory nutritional intake considering they now had a very small appetite. Care plans did contain some detail about peoples individual likes and wishes however there was also evidence that these wishes may not always be respected. An example being that one plan viewed stated that the person did not like mixed vegetables. On the day of the inspection visit there was an incident in the dining room and the person was upset stating they did not want to eat their lunch and was seen to have been given mixed vegetables on their lunch plate. The member of care staff said that they had just noted this and yet it was recorded in their care records that they did not like vegetables. Record keeping in respect of food, fluid or bowel action charts as well as daily recordings of care provided were either incomplete or evidence that people are not receiving the care they require. The home has a chart on which it is recorded when everyone has had drinks however these charts were not being completed fully on a regular basis. Other than at meal times and set drinks rounds (mid morning, mid afternoon) people were not seen to have access to hot or cold drinks. This is particularly important to make these constantly available when people are not able to ask for drinks themselves as was the case with some service users. From observation and the records seen people are not being offered sufficient fluids throughout the 24 hour period. There was very limited information about peoples physical health needs on care plans. One of the care plans seen contained no reference to the fact that the person had recently had a pace maker fitted. A representative of the provider visited the home to undertake a visit on their behalf towards the end of January 2009. The inspectors were provided with a copy of the report following this visit. The report identified some of the concerns the inspectors had in respect of the care plans and risk assessments. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 14 The report also identified that people’s health needs are not recorded on care plans. Care plans do not identify all of people’s individual current needs and do not inform the delivery of care to people. Risk assessments are either not present or if present have not been reviewed and do not clearly relate to people’s current needs. A requirement is made that everyone living at the home must have a care plan and risk assessments that clearly identify their current needs and how these are to be met. Care plans and risk assessments must be agreed with the persons whose plan of care it is and must be reviewed at least every month and when needs change. The person in charge and lead carers undertake wellness checks including recording observations of blood pressures. This had previously been carried out by the complexes wellness nurses and it was not evident what additional training care staff have undertaken to complete these tasks and to understand and act on the results of the checks they are undertaking. The home had not regularly been weighing people and this was discussed with the person in charge who stated that district nurses would weigh people if this were required. As stated although a wellness check had been undertaken on one person it was not apparent what action was being taken to address the person’s weight loss. The wellness check identified that the person was more confused and their abilities with grooming/hygiene were ‘declining assistance – reluctant with self care’ but the persons care plan had not been updated to reflect these changes. The person in charge explained the homes medication procedures to one inspector who viewed the medication administration records and storage arrangements for medication. The home has reviewed the arrangements for the handling of medication as a result of a safeguarding investigation following an incident when several people did not receive their medication following errors in the reordering of medication. The medication administration records were generally well completed although there were some gaps where it was not possible to identify from the record sheets if people had receved a specific medication at a specific time. The person in charge stated that she usually audits the medication record sheets at the end of the twenty-eight day cycle and would identify who had not fully completed the records and remind them of the need to maintain full and accurate records. However given that there had been a safeguarding concern regarding this it would be expected that this would be monitored closely to ensure that people receive their medication as prescribed. Where people are on a variable does of medication such as for pain relief or to help manage bowels it had not been recorded on every occasion how much medication had been given. The home uses a pre-dispensed system where possible. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 15 The home had information about ‘as required’ medications however there was limited individual information to guide care staff as to when people who may be unable to request ‘as required’ medication should be administered this. The home has a medications fridge for the storage of medications that must be kept at cooler temperatures. The temperature of the fridge was generally being recorded daily however on four days in February 2009 this had not been recorded. The home did not have a maximum, minimum thermometer therefore it is not possible to evidence if the fridge has exceeded advised temperatures and temperature recordings were only those of the fridge at the time they were taken. The home has a controlled medications storage cabinet that would conform to regulations for the storage of controlled medications if it had been correctly attached to a wall as detailed in the misuse of drugs (safe custody) regulations 1973. The home is accurately recording controlled medication however there are no page numbers in the front of the controlled medications book which makes it harder to identify the correct page for each medication held. The home is following good practise guidelines in respect of tamazepam in that it is recording this within the controlled medications book however the inspector found a new packet of this medication in the controlled medications cabinet that had not been recorded into the controlled medications book. It is important to have clear records so that people receive medication safely. Medication is therefore not being stored securely or at the correct temperatures. All medication is administered by the lead carer on each shift. Care staff confirmed that they had undertaken additional training to undertake this task. The inspectors did not observe the medication administration during the visit. Neither of the comment cards from service users raised any concerns in respect of privacy or dignity. The inspectors did not observe any concerns during their visits to the home other than one bedroom which had a strong unpleasant odour which would affect the dignity of the occupant should they wish to entertain visitors in their room. The unpleasant odour also indicated that the person’s needs in respect of continence management are not being fully met. The commission has received several notifications of incidents when service users have entered another service users bedroom. Sunrise Operations Bassett Ltd DS0000068064.V374026.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 good. This judgement has been made using available evidence including a visit to this service. The routines for daily living and activities made available however information about people may not be included on care plans and not translated into practise. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings. EVIDENCE: The inspectors observed how people spent their time, spoke with people who live at the home and staff. Information from comment cards received and information from care plans is also considered. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. People are able to choose where in the home they spend their day; some were seen to spend time in the homes lounge areas with others, sitting in various chairs positioned along the homes hallways and in the dining room. People were observed moving about the home as they wished. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 17 People are given choice over their meals with options being chosen at the time of the meal from sample plates of the day’s options. Information in daily records indicated that people can get up and go to bed at various times of their choosing, one recording that a person liked to stay up till about midnight before going to bed. Bedrooms seen contained personal items brought into the home. Two care staff completed comment cards and both identified that providing choice and respecting peoples individuality were things the home did well. As part of the pre-admission assessment people or their relatives complete resident profile detailing social and leisure interests and life history information. These were seen in care plans viewed, however as stated in the previous section the information on care plans may not be translated into practice an example being that care staff were unaware that a person disliked vegetables. The AQAA stated that the home has an activities champion whose role is to ensure that activities offered are more person centred. Throughout the inspection visit the inspectors observed a range of activities within the home however not everyone joined these activities and it was not evident how individual activities were provided. Comment cards from people who live at the home stated that there were always (1) and sometimes (1) activities that they could join in with. The home also has a range of reminiscence items located around the home that may be of interest to people and stimulate memories and discussions. The AQAA stated that the daily notes recorded activities people had joined in with however there was limited information in daily recordings about how people had spent their time. There was no information in any care plans seen or daily records viewed that people had been able to enjoy outings. It is therefore not possible to determine the extent that people join in with the activities offered. Discussions with care staff identified that in addition to care they had to do some domestic activities such as laundry and cleaning. This was discussed with the person in charge who stated that the small laundry in the home was intended only for use as part of an activity with a service user and that laundry should be sent to the main laundry on the ground floor of the complex. The report following a visit by a representative of the provider undertaken at the end of January 2009 stated that at times there were no activities occurring and that the daily activities calendar was displayed however this had not been adhered to. The person in charge identified on the homes AQAA that they could do better with ‘greater understanding and relevant training of how to get more benefits of using the relaxation (snoozelen) room’. The AQAA also identified that the home planned to improve over the next twelve months by providing ‘more people centred activities’. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 18 The home has a relaxation room, lounge dining room and a seating area in the entrance area to the home where the two hallways providing access to the bedrooms join and communal facilities are provided. Seating in the lounge area is appropriate for the size of the home and needs of the people living there. People were observed sitting in various parts of the lounge and other parts of the home. People were receiving visitors during the inspection visit and although the home does not have a designated private area for visiting there are a variety of places where people could sit if they required more privacy than the main communal areas. One relative spoke to an inspector when they visited their family member. They said that they visit every day and are always made welcome. They said that they did not have the opportunity to eat with their relative, but were always offered a cup of tea, when hot drinks were served. The home is pleasantly decorated with a range of pictures and interesting items. The inspectors were informed that these had been sent from America where the parent company is situated. The inspectors were concerned that in some instances the cultural background of the people living at the home had not been fully considered. An example being the use of door labels and titles such a Janitor an American term that may not be relevant for a service user group made up predominately of English older people. This was discussed with a senior person at the home who did not appear to have considered this or view it as an issue. The home has a dining room providing sufficient seating should all service users wish to eat in the dining room. People can choose where they sit and seating is at small tables for up to four people. The report following the visit to the home on behalf of the provider identified that the tables in the dining room were laid mid morning and looked attractive. The inspectors were not present in the home prior to lunch however the practise of setting tables for a meal too long before the mealtime should be reconsidered, as this does not represent good practise in a home for people with dementia. People with Dementia will take clues from their environment and if tables are laid they may predict that it is now time to sit down for a meal. Comment cards from service users stated that they always enjoy the meals. Care plans contained information about special diets that people may require. The AQAA stated that a dining council meets monthly and that visitors are able to eat with their relatives. Concerns in respect of fluids and nutritional intake and how this is monitored are raised in the previous section of the report. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 19 Sunrise Operations Bassett Ltd DS0000068064.V374026.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a complaints policy which people are aware of however it is not evident that all complaints are investigated and people informed of the outcome. People are not being satisfactorily protected from abuse. EVIDENCE: Information from the homes AQAA, notifications, Provider Regulation 26 report, comment cards received, discussions with the person in charge, staff and records viewed are considered. The AQAA stated that when a new person moved into the home they are given a copy of the Sunrise complaints policy and procedure. Comment cards from people who live at the home stated that they all knew how to complain. Due to the level of cognitive disability of the people who live at the home it was not possible to discus complaints directly with them. No complaints about the home were made to the inspectors during the visit to the service or in comment cards received. Comment cards from staff also stated that they were aware of what to do if a person or their relative wished to complain or raised a concern. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 21 The AQAA did not state if any complaints had been received over the past year. The report following that visit by a representative of the provider contained a section about complaints. This identified that the last complaint was received in September 2009 and that there was no evidence of an investigation having been written up and no outcome. The home stated in the AQAA that it has a policy and procedure relating to safeguarding adults and ensuring that people are not at risk of abuse. Care staff informed the inspector that they had attended safeguarding adults training. Training records seen on the administrator’s computer and a copy of the company induction training programme was viewed and evidenced that staff have undertaken safeguarding adults training. New staff confirmed that safeguarding is part of induction. Soon after the inspection visit the commission received a notification from the home about an incident in which one service user has put at risk the physical well-being of another service user potentially placing them both at high risk. The notification was receive four days after the incident. The inspector telephoned the home to request further information about the incident and the action the home had taken to prevent a reoccurrence and safeguard all the people who live at the home. The home has not reported the incident to the local safeguarding team as required under local safeguarding procedures and had taken no action to prevent a reoccurrence and ensure the safety of people living at the home. The inspector completed a safeguarding referral to the local social services team. The home, on the inspector’s advice, had tried, but said that they could not get through to Social Services; as it had taken them time to find numbers. The Commission informed the out of hour’s service given the seriousness of the concern. There had been previous incidents in relation to this service user and the persons care plan did not contain guidance for staff as to how to manage such incidents. Information in the notification demonstrated that care staff were not equipped to deal with the incident and had themselves also been physically threatened during the incident and put at risk of harm. The home has therefore failed to protect people who live at the home placing them and staff at high risk of assault or injury. There was no evidence that all staff have attended additional training such as dementia, challenging behaviour, depravation of liberty or mental capacity act training. These all being very relevant for a service specifically for people with Dementia. Information from the homes training records evidenced that not all staff have undertaken all mandatory training specifically in manual handling. A small number of people living at the home have manual handling needs and will be being placed at risk if staff do not have the necessary training to move them safely. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 22 Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean, safe, well-maintained home that provides people with pleasant living accommodation. The home does not fully ensure that people are protected from all identified risks in the environment, including infection control. EVIDENCE: The inspectors had not previously visited the home so requested the person in charge to show them round towards the start of the inspection. They were then able to move around the home independently throughout the rest of the inspection visit. The home was purpose built to provide a high standard of accommodation. The home is furnished to a high standard and does not appear clinical. The home Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 24 has its own maintenance person and cleaning staff. The home was generally clean and free from offensive odours however one room the inspectors viewed had a strong unpleasant odour. The report completed by a representative of the provider also identified some areas of the home that were not up to standard in respect of cleaning and infection control. Comment cards from two service users all stated that the home is always fresh and clean. Bedrooms are either single ensuite rooms or two bedroom suites sharing a shower and WC. The inspectors noted that bar soap and toiletries had been left in some of these shared facilities that represents a risk of cross infection if picked up and used by different service users. The home also has two assisted spa baths. Both bathrooms were noted to have a non-washable chair in them that is an infection control risk. Care staff confirmed that they have ample supplies of infection control equipment including disposable gloves and aprons and protective hand gel. Care staff also confirmed that they have attended infection control training. The home has a range of communal facilities including spacious pleasant dining area and large lounge that is divided into several seating areas and separate activities room. The home has an accessible enclosed balcony leading from the communal areas and overlooking the complexes rear gardens and the city of Southampton towards the forest. The home is accessible via two passenger lifts. The home has all the necessary equipment for moving and handling with the AQAA stating that the wellness team are responsible for the maintenance and servicing of equipment. Sunrise Operations Bassett Ltd DS0000068064.V374026.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of staff who should be able to meet people’s needs. Staff have not all received the necessary mandatory training and have not received sufficient specific training to equip them with the skills to meet people’s specialist needs. Generally the home has good recruitment procedures. Less than fifty per cent of care staff have an NVQ in care. EVIDENCE: All comments and comment cards were positive about the homes staff. Two comment cards were receved from people who live at the home, they stated that staff always listen and act on what they say, with one adding that ‘sometimes it can take a while though for my message to get through and be acted upon’. The comment cards also stated that staff were usually (1) and always (1) available when they need them. Duty rotas were seen during the visit to the home. Duty rotas stated that one lead care manager and six care staff are provided in the morning; one lead care manager and four care in the afternoon/evening and one lead care manager and two care staff at night. Some of the people living at the home have been assessed as requiring a higher level of support and this was initially Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 26 described by the person in charge as one to one care however following discussion it was identified that this is not one to one but reflected that they required two care staff for some care such as manual handling. The manager was not included on the duty rota and the hours that she is planning on being in the home and actually works must be recorded. Cleaners, maintenance and kitchen staff are also employed however they do not appear on the homes duty rota. During the inspectors visit staff on duty corresponded to those on the duty rota. The homes duty rota only contains first names of staff and first and surnames for staff should be included on duty rotas. Care staff stated that they generally have sufficient time to meet people’s needs. Comment cards from staff stated that there was always (1) and usually (1) enough staff to meet people’s needs. One added that the home was ‘well staffed’, and ‘very close team’. The inspectors were shown the homes training matrix on a computer that evidenced that not all staff have completed all mandatory training. An example being that not all staff have completed manual handling training. A copy of the report completed on behalf of the provider identified that care staff were receiving manual handling training and that this lasted approximately two hours. The person stated that there were new staff members attending and they had concerns as to whether this was a long enough session to ensure they were all competent. It was also noted that an existing staff member attending the session stated that it had been helpful as they had not previously been sure how to use the standaid. One of the care staff who completed a comment card stated that ‘i’m experienced in care giving also familiar with the company but after six months some trainings are still outstanding’. The other staff member identified that the service could do better with providing ‘more regular supervision’. In response to a question on the comment card about training it was stated ‘lead care managers and care managers work closely together to cascade relevant knowledge’ and that ‘the coordinator also plays an active role in the unit informing staff of new developments’. The home must ensure that all staff undertake all mandatory and relevant additional training and that training is of a sufficient standard to equip staff with the skills they need to meet people’s needs. Information on the AQAA stated that ten of the homes twenty-four care staff have an NVQ of at least level 2 in care and that a further three care staff are undertaking this qualification. At present therefore slightly less than fifty percent of the care staff have a qualification in care. The home should consider how it will encourage staff to gain a qualification in care. The recruitment records for two staff recently recruited to the home and on duty on the day of the inspection were viewed. These contained information Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 27 that confirmed that staff have Criminal Records Bueoro and Protection of Vulnerable Adults checks and that two references had been obtained before people commenced employment at the home. The inspectors were shown the homes two week induction programme which includes both classroom ‘training’ covering all mandatory subjects and shadow shifts working in the home. The inspectors were also shown the skills for care workbooks staff complete. The inspectors spoke with new staff who confirmed that they had attended training at another of the providers homes and completed shadow shifts before commencing work at the home. The new staff also confirmed that full recruitment procedures and pre-employment checks had been undertaken. Comment cards from staff also confirmed that preemployment checks were completed and that they had undertaken an induction. Sunrise Operations Bassett Ltd DS0000068064.V374026.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The person in charge of the home is not currently registered as the homes registered manager. People are consulted about their home and a representative of the provider identified many of the concerns raised in this report during a visit they made to the home at the end of January 2009. The home has not kept the commission informed of all notifiable incidents or events in the home. People’s financial interests are safeguarded. The home does not currently act to fully ensure the safety, health and welfare of the people living at the home which puts people at risk. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 29 EVIDENCE: The home does not currently have a registered manager. This was also the situation when the home was previously inspected in February 2008 when it was noted that the home had been without a registered manager for several months. The person in charge at the time of this inspection stated that they would be applying to become the homes registered manager and had commenced the process and was now awaiting the return of their commission CRB check and would then submit an application to the commission for registration as the homes manager. The person in charge has been managing the home since September 2008 and the commission would have expected an application before this date. The commission wrote to the responsible individual in October 2008 requesting information about the management arrangements at the home but did not receive a reply. The AQAA was completed by the person in charge and had been returned when requested. The AQAA was completed to an acceptable standard and identified some areas where the home could improve. However the AQAA failed to identify many of the issues identified in the providers report or during the inspection putting people at risk of not receiving a well organised and managed service, where issues are identified and responded to. The inspectors were provided with copies of the visits undertaken to the home on behalf of the provider (Regulation 26 visits). The visit undertaken in January 2009 identified some of the issues and concerns noted by the inspectors. The inspectors identified other concerns and will be requesting an improvement plan from the home. The arrangements in respect of people’s personal finances were discussed with the person in charge and with the complex administrator who showed the inspectors copies of invoices and records of money held on their behalf in the safe. The invoices were itemised and clearly showed what additional services such as hairdressing were being charged for. The records of peoples personal money held on their behalf were also viewed and indicated what money people had spent. The home keeps a variety of records relating to peoples care such as care plans, risk assessments, medication records, incident sheets, fluid, food and bowel records. Requirements have been made in respect of these and the home must ensure that full and accurate records are maintained. Concerns in respect of the safety of people living at the home have been raised in that there is evidence that they are not always receiving the care they require and staff have not all completed all mandatory or additional training. Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 30 People have been placed at risk by the homes failure to take the necessary action following incidents when people have been physically assaulted. Concerns in respect of the storage and administration of medication and infection control have also placed people at risk. The lack of clear guidelines for safe moving practice and issues identified in connection with staff training in respect of moving and handling training puts people at risk. Whilst viewing daily records and incident forms in the home there were events affecting the wellbeing of service users that were not reported to the commission as required under regulation 37 of the Care Standards Act. An example being when there was an outbreak of sickness and diarrhoea in the home such that district nurses would not visit to redress a person’s wound. The homes AQAA identified that the maintenance team ensure that all equipment and services are monitored, window restrictors are in place and fire detection equipment are tested weekly and fire drills conducted. The records for these were not viewed on this inspection visit. Sunrise Operations Bassett Ltd DS0000068064.V374026.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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X 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 X 2 1 Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 32 NO Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15 Requirement The responsible person must ensure that all risk assessments and care plans fully reflect all people’s current health, personal and social care needs and are reviewed and updated. The responsible person must ensure that the home is conducted so as to make proper provision for peoples health and welfare. The responsible person must ensure that staff receive all mandatory and other training relevant to the needs of the people who live at the home. The responsible person must ensure that people living at the home are safe from the risk of abuse. Timescale for action 01/04/09 2. OP8 12 01/04/09 3. OP30 18 01/06/09 4. OP18 13 01/03/09 Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 33 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 Good Practice Recommendations Sunrise Operations Bassett Ltd DS0000068064.V374026.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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