Inspection on 16/02/09 for Sunrise Operations Bassett Ltd (Assisted Living)

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

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Sunrise Operations Bassett Ltd (Assisted Living) 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 (Assisted Living) DS0000072375.V374027.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 (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunrise Operations Bassett Ltd (Assisted Living) 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 Care Home 75 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.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 with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 75. Date of last inspection New Service Brief Description of the Service: Sunrise Operations Bassett Ltd (Assisted Living) is a registered nursing home able to provide nursing care and accommodation for up to 75 older people. The nursing home is located on the lower three floors of a large complex which also provides a separate residential home for people with dementia on the upper fourth floor. The nursing home was registered on the 30th September 2008 and provides all single rooms with either ensuites or shared (with one other room) bathroom and WC facilities. Communal facilities are provided including a spacious dining room, and large lounge divided into two sections one with a bar area providing hot and cold drinks. A separate activities room is provided on the second floor. A small car park area is provided to the side of the home and to the rear there is an accessible garden. All areas of the home are accessible via a passenger lift. The home is owned by Sunrise Operations Bassett Ltd and at the time of this key inspection did not have a registered manager. Weekly fees range between £595 and £1050 for accommodation (dependant on room occupied) with additional care fees commencing at £140 per week and increasing dependant on assessed nursing/care needs. Additional charges are made for hairdressing, chiropody, manicure, newspapers and some other services. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 5 Full information about current fees is available from the home. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 6 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. All core standards and a number of additional standards were assessed. The visit to the home was undertaken by two inspectors and lasted approximately ten and a half hours commencing at 11.30 am and being completed at 9.30 p.m. The inspectors were able to spend time with the person in charge and staff on duty and was 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. Four comment cards were received from people who live at the home and five responses were received from staff who work at the home. The service was registered on the 30th September 2008 and information from the registration report is also considered. 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 home’s 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 a welcoming and comfortable home. The home has a comprehensive 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 (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 7 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: Two immediate requirements were made following the key inspection visit. The home must ensure that people receive their medication at the time that their medical practitioner has prescribed it to be administered. The home must ensure that substances hazardous to health are stored securely at all times. Additional requirements are also made in that:Care plans do not identify all of people’s individual 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 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 their needs responded to. The home must ensure that medication is stored securely and at the correct temperatures. People must not have access to out of date medication. 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. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 8 Other areas that the home could improve are also detailed in the relevant outcome areas in the following report. 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 (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 9 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 (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 10 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. All people are assessed prior to moving into the home however the lack of up to date care plans and risk assessments may mean that peoples needs will not be met. 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 home’s admission procedure was detailed in the AQAA and pre-admission assessments were viewed for people admitted shortly before the inspection visit. The inspectors discussed new admissions with staff and comments from surveys completed by people who live at the home and staff are also considered. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 11 The AQAA detailed the home’s admission procedure stating that all prospective residents and their families are invited to visit the home prior to their stay and where several rooms are available people are provided with a choice. The AQAA stated that the home always undertakes a preadmission assessment completed by one of the qualified nurses and the person in charge of the nursing home. The AQAA also stated 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 it gets a report from the person’s GP before they move in. 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 person’s 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. At the time of the home’s first key inspection it had not admitted any service users needing nursing care according to feedback from the staffing team. People living at the home had either been assessed as requiring residential care or had previously been living at the home when it was an assisted living community with a domiciliary care service. Copies of GP reports were seen in service files as stated in the AQAA. The inspectors were able to speak with several people and a relative who confirmed the above procedure had occurred. Comment cards from people living at the home stated that they had all received a contract and had all received enough information about the home before they moved in. Copies of contracts were seen in service users administration files with amendments when care rates had increased. A relative confirmed that they had been provided with information about the home before their relative moved in. The service had previously been a supported living community with an on site domiciliary care service. The relative stated that they had been informed about the changes to the service and that it would now be a nursing home. One of the service users files viewed contained evidence that the home had reassessed a person who had been admitted to hospital prior to their discharge back to the home. The person in charge stated that they would always reassess people who had been in hospital to ensure that their needs could continue to be met at the home on discharge. However there was no evidence that the person’s care plan had been update to reflect their changed/increased needs on discharge from hospital or guidance for care staff as to how the person’s needs should now be met. This is further discussed in the next section of this report. The home does not provide dedicated accommodation for short-term, intermediate care or specialised facilities for rehabilitation. However, respite care is provided, if there is a room available. There was no evidence that this Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 12 arrangement had any negative impact on the existing residents. The admission procedures are the same for respite or short stay service users as for permanent service users. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not identify all of people’s individual current needs and do not inform the delivery of care to people to ensure that all their needs and wishes are met. There is a failure to complete risk assessments for identified risks and to review them so that they meet people’s changing needs. People are therefore at risk of not having their needs met. People are treated with respect and their dignity is not always maintained. All medication is not securely stored, putting people at risk of harm. The medication is not stored at the correct temperature and has not been administered at the times prescribed so that medicines are effective in meeting people’s health needs. EVIDENCE: Four care plans were viewed, one for a new person and the other’s for people 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 Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 14 arrangements for the storage and administration of medication and related records were viewed and discussed with the qualified nurse on duty and person in charge. Comment cards from people who live at the home stated that they always (3) and usually (1) received the care and support they required. They also stated that they always (4) received the medical care they need. The inspectors viewed care plans for people receiving residential care within the nursing home. One of the care plans viewed was for a person who had recently been readmitted to the home and whose care needs had increased following a hospital stay. The person had been reassessed by the home prior to discharge from hospital and this identified that they were at risk of falls, required grade 1 thickened fluids and a soft diet. The inspectors observed the person and their room and viewed the records held in the person’s room as well as those in the office. The date of the care plan was the 02/04/08. This appeared to have been reviewed once on the 02/10/08 and had not been updated since the persons hospital admission and readmission to the home approximately two weeks prior to the inspection visit. The care plan no longer responded to the person’s care needs and would not inform staff as to how to care for the person. The person was now receiving thickened fluids and this was not recorded on the eating and drinking section of the care plan. A container of thickener was present in the person’s bedroom. Discussions with care staff evidenced that they were unclear as to the level of thickness that fluids should be offered to the person. The person was being cared for on a pressure relieving mattress however there was no pressure area risk assessment or additional information in the person’s care plan concerning the use of the pressure mattress. The person did not appear to have been weighed since September 2008 and the pressure mattress was set towards the firmer setting which would be for a person weighing more than the person weighed either from their last recorded weight or observation of the person. Discussions with the care staff indicated that they were unaware of pressure mattress settings and a copy of a fax sent from the home to the local district nurses evidenced that the qualified nurses in the wellness team were also unaware of the need to ensure that pressure mattresses should be set dependant on the weight of the person. The fax stating that the mattress was ‘on the highest rate but remained soft so was not inflating correctly’. Inconsistencies were noted in the manual handling assessment for this person with the manual handling risk assessment dated 02/04/08 being the only one available and stating that the person walked with a frame, recent daily care records identified that a standaid was being used and a hoist was noted in the person’s ensuite bathroom. Care staff stated that they used a hoist. The home was recording fluids taken by the person and these indicated that the person was not being provided with regular fluids. On the day of the inspection visit by 5pm they had received a total of 300 mls of fluid (100mls being taken on three Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 15 separate occasions). The records of fluid intake for the previous days also failed to evidenced that adequate fluid intakes were being provided. The care plan for another person admitted for a short stay stated that the person would be returning home once work had been completed on the person’s home. The person’s ability to self-administer their medication had been assessed by the home and stated that the person would not be able to self-administer their medication and that this task would be undertaken by the care staff. However as the plan stated on the care plan was for the person to return home there was no information on the care plan as to how the person would be supported to regain the skills of self-administration of their medication. The person’s care plan stated that they should be having their blood pressure checked daily and this had not been recorded on the two days preceding the inspection visit. The third care plan viewed also contained inconsistencies with daily records stating that the person was having some incontinence however the person’s care plan had not been updated and stated that they were continent. The person’s pre-admission assessment identified a tendency to constipation but there was no record of any monitoring for this. There was also inconsistencies about the level of support the person required with their medication in that the care plan identified that they could self administer their medication and other records stating that they had requested a prompt with their medication. The inspectors identified concerns in respect of the fourth care plan viewed with poor record keeping for fluid, food and bowel charts. There were no cold fluids available in the lounges, and no one was having a cold drink during the afternoon. Although people were offered a hot drink during the afternoon, as one relative commented, this is not sufficient. Cold drinks are available on request, but fluid charts, observation and the comment of a relative indicated that if cold drinks were in the communal areas, people may be encouraged to improve their level of hydration. The home has a bar area in the lounge from which people can get hot or cold drinks however the inspectors were concerned that less independent people who may not be in a position to request drinks would not receive adequate fluid intakes. The home should consider how it can ensure that all people have access to fluids at all times. This is particularly important as the home is now registered to provide nursing care that will result in more dependant people being admitted to the home. A bowel chart was in use on one care plan but this only recorded three occasions in January 2009 when the person had had their bowels open. The person had lost almost 3kg between September 2008 and January 2009. The person was receiving supplement drinks but there was no care plan in place to monitor weight loss. The only information on the care plan in respect of eating and drinking stating that the person required a vegetarian diet. A waterlow (pressure area assessment) had been completed for this person which evidenced that they were at a high risk of developing pressure injuries Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 16 however it was not clear from the care plan if a pressure relieving mattress was in use and how the person’s pressure area needs were being met. There was no evidence in care plans or risk assessments that they had been reviewed monthly, since the home became a registered as a care home with nursing, although there was evidence that people’s needs have changed and their care plans needed reviewing. Some appeared to have been reviewed six monthly and some had undated hand written entries where needs had changed. 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. Although there was evidence that there had been some meetings with service users and relatives, it was not clear that this informed care delivery, with one relative saying that their family member would prefer to eat later in the evening than at 5.30pm, but had not been offered this choice as part of their assessment of needs when they moved into the home. 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 had received a visit from a representative of the provider at the end of January 2009 approximately two weeks before the inspection visit. This identified concerns about the care plans and required that all care plans should be audited, shortfalls identified, should be reviewed monthly and contain information about health needs. The report from the responsible person also identified that care plans did not contain all risk assessments and risk assessments should be reviewed monthly. The report also identified that daily notes should be made for all people. 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 inspectors viewed the storage arrangements for medication, viewed records relating to medication and discussed the home’s procedures in relation to medication with nursing and care staff. Some people in the home have been assessed as being able to self-administer their medication and bedrooms have secure storage for medication. The assessments to determine if people are able to self-administer their medication were seen in care plans. There was no indication as to how often these are reviewed to determine if a person is able to continue to self-administer their Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 17 medication. The inspectors viewed some bedrooms and found out of date medication left unlocked in these rooms. The inspectors also found a tub of cream that had been prescribed for another person in a service user’s bedroom. The rooms themselves had not been locked and therefore the medication would have been accessible to any service users. The home must ensure that any out of date medication is removed from people’s bedrooms and that people only have access to creams that have been prescribed and dispensed for that person. The home has three medication trolleys, two kept in the nurse’s office and the other in a medication’s room. The trolley in regular use in the nurses office was not secured to a wall when not in use, there being no facilities to secure this trolley available. The staff were unable to find access the other trolley: they couldn’t find the key. The temperature of the medications room was being recorded daily by staff and this had been at recorded as being 26 degrees centigrade since 4th February 2009. There was a note on the 7th February 2009 that this had been reported to the maintenance man however this had not been followed up and no action had been taken to ensure that medication stored in this room was kept at a temperature that would not damage the medications efficacy. Most medication would need storing below 25 degrees centigrade. The home has a fridge to store medication that must be kept at cooler temperatures. This was equipped with a maximum/minimum thermometer and space was available on the temperature recording sheet to record fridge temperatures. There had been no recording of fridge temperatures on the current recording sheet that has been commenced at the start of February 2009. There was therefore no way to determine if medication had been kept at the correct temperatures in the fridge. 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. Medication is therefore not being stored securely or at the correct temperatures. A requirement is made that the home must ensure that all medication is stored securely and that its efficacy is not at risk by being stored at incorrect temperatures. Although the home is registered as a nursing home and has a qualified nurse on each shift they are not responsible for the administration of medication that is done by the lead carer on each shift. Discussions with care staff confirmed that the morning medications round can take between two and half and three hours. This means that some people will be receiving their morning medication Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 18 late in the morning after the time that it is prescribed to be given. The inspectors viewed the medications administration records at 7pm and this evidenced that some people had not received their 6pm medication. This was especially of a concern for people who have regular medication that should be given at set times or with set intervals such as for Parkinson’s or pain relief. One person who was prescribed medication at 6pm was due their next dose at 9pm and had not received their 6pm medication at after 7pm. A relative had had raised concerns about the late administration of their relative’s regular medication. Generally the medication administration records were well completed although there were a few gaps were it was not possible to identify if medication had been administered or not. There were some recording of the actual dose given on variable dose medication (such as pain relief or bowel medication) but this was not being recorded on every occasion. It was not possible to audit medication to determine if the correct amounts were in place as the home does not record when new boxes of medication are commenced in use or what is carried over to a new medication administration record sheet on all occasions. The home is accurately recording controlled medication however there are no names or page numbers in the front of the controlled medications book which makes it harder to identify the correct page for each medication held. It is important to have clear records so that people receive medication safely. The report following the visit to the home by a representative of the provider in January 2009 identified some concerns in respect of the homes medication and required that the home review all medication profiles and ‘as required’ protocols and that where an ‘as required’ medication has been administered this is recorded on the reverse of the medication administration record. An immediate requirement was issued during the inspection on the 16th February 2009 with a compliance date of the 18th February 2009 that the home must ensure that people receive their medication at the time that it has been prescribed by the person’s medical practitioner. Discussions with people who live at the home indicated that people felt that their rights to privacy and dignity were respected and choice promoted. All rooms are for individual use ensuring privacy during personal care tasks. The inspectors assisted a service user who was found walking up a corridor with her trousers and underwear around her lower legs as she looked for someone to assist her. One inspector provided immediate assistance to protect the person’s dignity and safety whilst the other sought out a staff member. The inspectors noted that continence products had been stored on view in two of the rooms they viewed. This does not promote the dignity of people living in the home. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 19 Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 20 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 are flexible and varied to suit people’s individual needs. 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 confirmed to the inspector that they 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 remaining in their bedrooms. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 21 People confirmed to the inspector that they are given choice over their meals with options being chosen at the time of the meal. People stated that they are able to get up and go to bed at times of their choosing. Bedrooms seen contained personal items brought into the home. One relative said that there were limitations in terms of choice regarding meal times. 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. The AQAA stated that the home provides a full time activities coordinator and part time activities assistants. Throughout the inspection visit the inspectors observed a range of activities within the home. Lists of planned activities were seen in the entrance area and people stated that they could choose to join activities or not. Comment cards from people who live at the home stated that there were always (2) and sometimes (2) activities that they could join in with. 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. In some care plans viewed daily recordings were not completed every day. This was also noted in the report following the visit by the representative of the provider at the end of January 2009 and an action was required by the providers representative that an entry in the daily notes must be made for each shift. It is therefore not possible to determine the extent that people join in with the activities offered. The home is now registered as a nursing home and it was not evident from the activities on display how people with nursing needs, some of whom would have to remain in bed or their rooms would access activities. The home has accessible transport. A relative informed the inspectors that his relative was not able to enjoy as many outings as they would like as these were not occurring as frequently. The AQAA stated that care staff are encouraged to participate in activities however discussions with care staff indicated that they did not have sufficient time to join activities due to other tasks they had to complete. One comment card identified that care staff also ‘had to undertake cleaning and laundry taking them away from service users’. The home has a large lounge divided in various smaller seating areas one with a bar area providing hot and cold drinks. Seating in the lounge areas 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 others stated that they had chosen to remain in their bedrooms. There is also a separate activities room although this was not seen in use during the inspection visit. There was a clothes sale when the inspectors arrived at the service. The home is pleasantly decorated with a range of pictures and interesting items. The inspectors were informed that these had been sent from America Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 22 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 and Concierge, both American terms 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. Also there were items in picture frames outside rooms, but they did not take into account necessarily the gender of the person accommodated, with a post card of an old sewing machine outside a gentleman’s room and an aircraft outside a female service user’s room. The records did not demonstrate that this reflected personal choice and memories. The home has a spacious dining room providing sufficient seating should all service users wish to eat in the lounge. People can choose where they sit and some have selected places that are designated by a name plaques. Seating is at small tables for two or four people. People informed the inspector that they could choose to have their meals in their rooms if they wished. Comment cards from service users stated that they always enjoy the meals and discussions with people who live at the home confirmed this. People stated that choice is available at all meals and this is chosen at the time of the meal. 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. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The home does not have the necessary procedures in place to ensure that people’s health and personal care needs are met placing people at risk of neglect. EVIDENCE: Information from the homes AQAA, comment cards received, discussions with service users and 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. Discussions with people who live at the home also evidenced that they were aware of how to complain. No complaints about the home were made to the inspectors during the visit to the service or in comment cards receved. 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 (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 24 The AQAA stated that the service had receved five complaints and that these had all been resolved within 28 days and that all had been upheld. This would indicate that people feel able to make complaints. The home 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 and were aware of the actions they should take if they suspected that abuse may have occurred. 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. The inspectors identified concerns in respect of the management of medication, care plans and risk assessments that evidenced that people’s health and personal care needs are not being met. Evidence in respect of this is recorded in the outcome group two health and personal care. 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. There was also no evidence that staff have attended additional training such as dementia or mental capacity act training. The homes policies and procedures in respect of recruitment do not currently fully ensure that unsuitable people are not employed at the home. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 25 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 meets their individual and collective needs. 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. An additional comment from a service user on their comment card being ‘Sunrise Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 26 is very well maintained, lovely gardens, dining room and lounge area are excellent – to five star hotel standards’. The home has its own maintenance person and cleaning staff. The home was clean and had no offensive odours. Comment cards from service users all stated that the home is always fresh and clean. Comment cards from care staff identified that they are also responsible for laundry and room cleaning. The only daily recording made for some people was room check. One relative identified that they had been unhappy with the standard of cleaning in their relatives room and that they had been informed that rooms were only cleaned once per week and that staff undertook a room check on other days. The relative stated that following discussion with the person in charge it had been agreed that the room would be cleaned more frequently. The inspectors noted on two occasions that cleaning trolleys had been left unattended in corridors providing people with access to substances that are potentially hazardous to health. An immediate requirement was made in that all substances hazardous to health must be stored securely. There were a number of wheel chairs in the environment, which could pose trip hazards. The nurse in charge said that she was hoping to address this issue. 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 an infection control risk. The home also has a range of assisted spa baths on each of the three floors. All bathrooms were noted to have a non-washable chair in them and one had a fabric bath mat on the floor beside the bath. Both also represent an infection control risk and the bath mat is also a trip 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 garden to the rear of the home. All areas of the home are accessible via 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. The registration report completed in September 2008 identified that a full independent fire safety risk assessment had been completed and that Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 27 Hampshire Fire and Rescue Services were present on the day of the registration visit undertaking fire safety awareness with residents and families. The registration inspector viewed certificates of installation and maintenance for fire safety equipment, installation including alarms, emergency lighting, electrical fixtures and fittings, gas fired central heating systems and water systems including chlorination systems. These were therefore not viewed on this inspection visit. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 28 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. Most staff have received the necessary mandatory training and good recruitment procedures are in place. The home must ensure that the registration status of all qualified nurses is checked as part of the preemployment checks. The home has approximately sixty per cent of staff with an NVQ level 2 or above in care. EVIDENCE: All comments and comment cards, from people who live at the home and visitors were positive about the homes staff. Comment cards from people who live at the home stated that staff always listen and act on what they say, and that staff were usually (2) and always (2) available when they need them. People felt that they receved the care and support that they required. Duty rotas were seen during the visit to the home. Duty rotas stated that one qualified nurse, one lead care manager and five care staff are provided in the morning; one qualified nurse, one lead care manager and four care in the afternoon/evening and one qualified nurse, one lead care manager and one carer at night. Cleaners, activities, administration, maintenance and kitchen Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 29 staff are also employed. The home does not currently have any nursing service users however when these are admitted the home will need to review the staffing levels to ensure that the needs of people with higher and complex care needs can be met. 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 although the mornings were very busy. Comment cards from staff stated that there was sometimes (1) and usually (4) enough staff to meet peoples needs. Throughout the inspection care staff appeared to have time to meet people’s needs. The inspectors were shown the homes training matrix on a computer that evidenced that most 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. Nursing and care staff stated that they felt they had the necessary skills to meet people’s needs and were not expected to undertake activities for which they had not been trained. Comment cards from staff confirmed that they were given training relevant to their role that helped keep them up to date with new ways of working. Comment cards stated that ‘relevant study days and courses are now being arranged for team members’. One staff member identified the ‘carers need more training and supervision especially as residents are coming in with more complex care needs’. The home must ensure that all staff undertake all mandatory training and that training is of a sufficient standard to equip staff with the skills they need to meet people’s needs. The home is now registered as a nursing home and the home must ensure that staff have the necessary skills to meet the more complex needs of nursing service users. Information on the AQAA stated that approximately sixty percent of care staff have an NVQ level 2 or above in care. The recruitment records for two staff recruited since the home changed its registration to become a nursing home were viewed. These contained information that confirmed that staff have Criminal Records Bueoro and Protection of Vulnerable Adults checks prior to commencing Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 30 employment at the home. One of the recruitment files viewed did not contain a reference from the persons previous employer which was a care provider, and the references on the persons file were both non professional one stating it had come from a friend and the other headed to whom it may concern which implies that it has been supplied by the applicant and not requested and therefore its authenticity guaranteed by the home. One of the staff files viewed was for a qualified nurse. There was no evidence in the persons file that their registration with the Nurses and Midwifery Council had been checked. A photocopy of the nurses registration card was provided however this does not confirm active registration only that the person was registered on the day of the cards issue. This was discussed and it was evident that the home was not routinely checking the registration status of the qualified nurses and advice was given as to how this should be undertaken when employing nurses and at yearly intervals as registration is renewed. The inspectors were shown the homes two week induction programme which includes both classroom ‘training’ covering all mandatory subjects and shadow shifts. 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 pre-employment checks were completed and that they had undertaken an induction. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 31 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 adequate. 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. 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 is promoted and they are not placed at risk. EVIDENCE: Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 32 The home has been registered as a care home with nursing for approximately six months. The person registered as the home’s registered manager at the time of the homes registration resigned soon after the home was registered. The provider has now appointed a person who stated that she has commenced the process to become the homes registered manager. The person is a registered general nurse and stated to inspectors that she has the necessary management qualifications and previous experience of managing nursing homes. The new manager was present throughout the inspection visit and presented as open and aware of issues that need addressing at the home. Comment cards from staff at the home stated that ‘the new manager is settling in well, is approachable and is looking to address a good many issues’. The first staff meeting is on Thursday 22nd January’. The new manager had arranged for night staff to come in early for a staff meeting on the day of the inspection meeting. The service was previously an assisted living community with an on site domiciliary care service. The majority of people living at the home were doing so before registration as a nursing home. Discussion with a relative showed that they had been informed about the changes and that the home was now a nursing home. However many of the homes practises are not those of a nursing home. Medication is still administered by care staff and District nurses continue to visit the home to provide nursing care such as injections and dressings. It was not clear what the qualified nurses role in the home is. The AQAA identified that the home holds various meetings with the people who live at the home including a dining council and residents meetings. Information about these was seen on the notice board in the lounge. The AQAA was completed by the person who had been in charge of the home in December 2008 when it was requested. The AQAA was returned late following a reminder letter. The AQAA was completed to an acceptable standard. 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 many of the issues and concerns noted by the inspectors. The new manager provided the inspectors with a copy of the action plan that she had produced to address the issues raised in the regulation 26 report. The inspectors identified other concerns and will be requesting an improvement plan from the home. Two immediate requirements relating to the secure storage of substances hazardous to health and the administration of medication at the times that it has been prescribed were made during the inspection visit. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 33 Additional requirements about records such as care planning, risk assessments, storage of medication are also made. 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. Concerns in respect of 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, staff have not all completed all mandatory or additional training and the storage and administration of medication has placed people at risk. Substances hazardous to health were not stored securely and infection control risks were identified and put people at risk. Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 34 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 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 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 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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 make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of all medication received into the home. The responsible person must ensure that all medication is administered as prescribed by the person’s medical practitioner. The responsible person must ensure that staff receive all mandatory and other training relevant to the needs of the people living at the home. The responsible person must DS0000072375.V374027.R01.S.doc Timescale for action 01/04/09 2. OP8 12 01/04/09 3. OP9 13 01/04/09 4. OP9 13 18/02/09 5. OP30 18 01/06/09 6. OP38 13 18/02/09 Page 36 Sunrise Operations Bassett Ltd (Assisted Living) Version 5.2 ensure that all substances hazardous to health must be stored securely at all times. 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 (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 37 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. Extracts may not be used or reproduced without the express permission of CSCI Sunrise Operations Bassett Ltd (Assisted Living) DS0000072375.V374027.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!