Inspection on 20/08/08 for Sunrise Operations Eastbourne Ltd

This inspection was carried out on 20th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunrise Operations Eastbourne Ltd 02/12/09

Sunrise Operations Eastbourne Ltd 03/09/09

Sunrise Operations Eastbourne Ltd 06/07/09

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunrise Operations Eastbourne Ltd (Reminiscence Neighbourhood) 6 Uppers King Eastbourne BN20 9AN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gwyneth Bryant     Date: 2 0 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sunrise Operations Eastbourne Ltd 6 Uppers King (Reminiscence Neighbourhood) Eastbourne BN20 9AN 01323525000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sunrise Operations Eastbourne Ltd Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 26. 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: Dementia (DE). Date of last inspection Brief description of the care home Sunrise is a purpose built building situated close to the A22 on the outskirts of Eastbourne and is part of a retirement complex. This building is comprised of three floors with the upper floor is a registered as a service providing care and accommodation for people with a dementia type illness and the first and second floors are registered as a care home with nursing. Accommodation mainly comprises single occupancy bedrooms with larger suites for couples also available. All bedrooms and suites have full en-suite facilities and a kitchen area that includes a refrigerator and sink unit. Passenger lifts provide access to all floors. The top floor is exclusively for Care Homes for Older People Page 4 of 31 Over 65 0 26 Brief description of the care home those people who have a dementia type illnesses and is known as the Reminiscence Neighbourhood. Communal bathing facilities, including assisted baths and spar baths are available on all floors. In addition there is an activities room, dining room and lounge. There is also a number of smaller lounge areas on each floor and the gardens are well maintained and fully accessible. The fees for accommodation are separate to those for care with rooms costing from 167 pounds to 150 pounds per day for accommodation including meals, laundry services, continence management and assistance with washing and dressing. For those people who need more than 3 hours care per day an additional hourly charge of 18 pounds is payable. Additional charges are made for chiropody, hairdressing, guest meals and dry cleaning. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection and took place over eight hours. The purpose of the inspection was to check compliance with key standards and other standards. There were seven people in residence on the day of which four were spoken with. The Executive Director, the activity coordinator and two staff were also spoken with. A tour of the premises was carried out and a range of documentation was viewed including care plans, personnel and medication records. One person spoken with said that staff were very kind. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some Care Homes for Older People Page 6 of 31 numerical information about the service. This was provided and the information included in this report as necessary. The CSCI Pharmacist Inspector also visited the home during the site visit and her findings are included in this report. The fees for accommodation are separate to those for care with rooms costing from 167 to 150 Pounds per day for accommodation including meals, laundry services, continence management and assistance with washing and dressing. For those people who need more than 3 hours care per day an additional hourly charge of 18 Pounds is payable. Additional charges are made for chiropody, hairdressing, guest meals and dry cleaning What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the pre admission assessment to demonstrate the home can meet the needs of people moving into the home and the information on action taken if people do not wish to pay for additional care. Evidence: The Executive Director confirmed that all prospective residents are provided with a copy of the Statement of Purpose and Service User Guide with the information on charges being supplied on a separate sheet. The service offers separate charges relating to accommodation and care provided. However, it is not clear what would happen if the individual disagreed with the care assessment and therefore decided not to pay the additional care fees. To ensure transparency it is important to outline whether or not an independent assessment could be provided or if the individual would be asked to leave. Three pre-admission sheets were viewed and although they included all the information required by the standard, they mostly consisted of tick Care Homes for Older People Page 10 of 31 Evidence: boxes and did not include how the home will meet assessed needs. There was little information in respect of the need for dental treatment, opticians or chiropody. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to all aspects of the care planning process, including risk assessments, meeting healthcare needs and there is a need for competence skills assessment of staff handling medicines on a regular basis to ensure safe practices are used when dealing with medicines. Evidence: Three care plans were viewed and while they included most aspects of care needed there were a number of shortfalls, in particular with the lack of direction to staff in the delivery of care. The care planning systems consists of an individual service plan, resident profile, 24 hour care summary, risk assessments and GP assessment. One care plan showed the review date as January 2009 and this is not acceptable due to the level of dependency of people living in the home. The resident profile outlines preferred times of rising, going to bed and dietary likes and dislikes and the 24 hour care summary outlines how the person likes to spend their day. The care plan format is that they are person centered and are generic in design but it Care Homes for Older People Page 12 of 31 Evidence: is evident that staff have not received the training to enable them to understand how to complete them. It is important to ensure staff understand how to complete the plans to ensure that care is delivered in a consistent manner at all times. While care plans identify most needs they do not include detailed action that staff need to take to meet care needs. For example one persons past and present leisure interests were clearly identified but there was no information as to what staff need to do to meet them. There were also inconsistencies between the Individual Service Plan (ISP)and the 24 hour care summary in that for one person the ISP says they like to get up 7.30-8am but the care summary says 8.30-9am therefore staff would not know what time to wake this person. One person is identified as enjoying long walks and when this was mentioned to staff one carer said he can no longer manage long walks but another added that he did have lots of walks in the garden. None of this was reflected in any of the care planning documents. Although people are weighed reguarly there is no follow up direction to staff if someone has lost weight such as offering high calorie drinks. It was of concern that one person who was admitted from the nursing home unit did not have a new care plan and the risk assessments for this person showed that the Assisted Living staff are responsible for action rather that staff in the Reminiscence Neighbourhood. Another persons resident profile stated that they liked scrambled egg for breakfast but they were not offered this on the day. An assessment for falls and tissue breakdown for one person could not be found and this is of concern as some people living in the unit are of high dependency. The pre-admission assessments do not include detailed information as to how peoples healthcare needs will be met these needs are not carried forward into the care planning system, therefore there is no information on meeting chiropody, dental, eyesight and hearing needs. A number of people have medication as required (PRN) but the triggers for their use is not outlined in the care plan and as people in this unit are not always able to verbally express a need it is important to ensure staff are aware of other signs of need. Overall a number of care plans and related documents had not been signed or dated, or not fully completed and this needs to be addressed to ensure it is clear when reviews need to be carried out and provide an audit trail. Daily notes often consisted of tasks carried out such as washing someone or assisted with all care rather than giving good information as to how the individual spent their day. However, staff spoken with had a good knowledge of individual needs and how people spent their day. It is important to ensure that daily notes accurately reflect how people spent their day to ensure consistent and good quality care is provided and to provide vital information for the care plan review process. Staff spoken with were aware of individual care needs and how to meet them in a person centered way but this is not reflected in the care planning documents. It is important to reflect both a persons needs and where their condition has improved to provide a balanced view of the individuals daily life.though basic risk assessments had been carried out for those at risk of tissue breakdown, Care Homes for Older People Page 13 of 31 Evidence: manual handling or of falls, they were inadequate as they did not clearly identify the hazards nor include sufficient detail for the management of these risks, this was the case even for those people identified as having a history of falls. Risk assessments were generic in format and therefore did not take into account individual disabilities and capabilities. Most risk assessments referred to staff following certain policies and procedures but risk assessments need to be about the person concerned as staff should always follow the homes policies and procedures as part of good practice. The morning medication round was observed and it was of great concern that one person had there pain relief over an hour late as the person administering the medication could not find someone to provide a second signature for the controlled drug. Therefore the person concerned was in great pain as the purpose of certain medication is to control pain and ensure it does not become too extreme. Medication Administration Records (MAR) were viewed and there were a number of shortfalls including signatures scribbled out, signatures overwritten, gaps and frequent occasions when medication was out of stock. As a result of these shortfalls the CSCI Pharmacist Inspector was requested to visit to carry out a detailed audit of medication procedures. The pharmacist inspector visited the home on 22 August 2008 and the findings were that special additional instructions for a medicine to be given on an empty stomach and with a full glass of water were not complied with. The care plans had no information on medicine prescribed on a when required basis to give staff guidance on criteria to look for as to when to give the medicine. This would ensure that there is consistency in the use of this medicine and a person centered approach is used. Good medicine profiles are available. A few residents were on a medicine which relies on dose changes following the results of a blood test. The communication of this change in dosage directions is clear. For a resident a medicine was marked out of stock for 5 days. This is unacceptable for continuity of treatment as intended by the doctor. For another resident medicine had not been given for two days although it had been received. There is a special room with lockable cupboards to store medicines safely. The Controlled drugs cupboard was available but was not attached to the wall and this is being addressed. A trolley is available to use during administration and there is a lockable fridge and temperature records of the room and the fridge are kept ensuring that temperatures are monitored ensuring correct storage of medicines. The lunch time medicine administration was observed and good practice was followed. Photo of residents are available but these are not dated and signed and this needs to be rectified. A review of the Medication Administration Record (MAR) chart revealed that competence skills assessment around medicine management is needed as a there were a number of gaps in the records and frequent occasions when medication was out of stock. The home has policies and procedures and these need to be amended to provide clear guidance specifically for this service. Care Homes for Older People Page 14 of 31 Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Sunrise do not have the opportunity to have their expectations met in respect of maintaining control over their daily lives but their expectations are met in respect of meals and activities. Evidence: While preferred terms of address were identified in the care planning documents, staff were heard to address people in terms of darling or my love. It is evident that staff use of such endearments is well intentioned it does not take into account individual preferences and therefore impinges on peoples dignity. It was of concern when one person said they did not want an audience whilst being administered with a medication patch and the carer did not act upon the comment and this demonstrates a lack of understanding of how to maintain peoples dignity and privacy. People are able to have breakfast at times of their choosing and this was evident with people coming to the dining area when they were ready for breakfast. Menus are well balanced, nutritious and varied and the weekly menu is displayed in communal areas. It was of concern that no one was asked what they would like for breakfast, staff just gave them toast and cereals although one persons care plan clearly stated that they like scrambled egg for breakfast. In addition one person said they did not feel hungry but staff did not Care Homes for Older People Page 16 of 31 Evidence: have the time to encourage them or offer a range of alternatives, although the carer administering medication expressed concern that the person took a number of strong pain killers but did not eat. It appears that this situation occurred purely as a result of insufficient staff being available to meet the needs of these more dependent people. It was good to see that people are able to get hot drinks from a machine whenever they feel like it and staff confirmed that two people do so. The lunchtime meal was observed and as there were more staff available, people were able to eat their meal in a leisurely fashion with staff encouraging poor eaters and offering a choice of meals and second helpings. It was also good to see that daily notes showed that if people got up at night they were given a hot drink and a biscuit and enabled to stay up for a chat before being taken back to bed. After lunch staff engaged with people in a number of activities such as puzzles or just a chat and one person spoken with confirmed there are activities available regularly. Following the site visit a discussion with the activity organiser for the assisted living unit found that one person from the dementia unit was maintaining the homes Library as they were a librarian during their working life This indicates a good understanding of providing activities that are based on individual preferences even if they are not always based on past preferences. Visitors are welcome at all times and all families are given the key pad code to enable them to visit at times convenient to them. Security measures are in place to ensure people and staff living in Sunrise are not at risk from unwanted callers. The veranda areas are enclosed and used to grow edible herbs and flowers which are planted and tended by people living in the home as part of the activity programme. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure with evidence that people feel that their views are listened to and acted upon and individuals are further protected by satisfactory safeguarding adult procedures. Evidence: Information provided prior to the site visit confirmed that the service has policies and procedures on both complaints Safeguarding Adults. All complaints and incidents are recorded and held on the individuals file as part of the care planning process. All complaints and incidents are copied to the Wellness Coordinator who collates them and then makes suitable adjustments to reduce further complaints or incidents. There is a detailed staff training programme that ensures all staff have training in Safeguarding Adult procedures and staff spoken with demonstrated that they would know what to do in the event of an allegation. Care Homes for Older People Page 18 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All parts of the home are homely, safe, well maintained and comfortable ensuring that it is a pleasant place in which to live. Improvements need to be made to food handling practice and access to call bells. Evidence: A tour of the premises was carried out and a random selection of bedrooms viewed. All rooms checked were light, airy and have full en-suite facilities. As the home is purpose built all rooms meet at least the minimum size standard and corridors, lifts and doorways are wide enough to accommodate wheelchairs. There are a range of aids and adaptations to promote the independence of people living in Sunrise, such as grab rails, toilet riser seats and hoists. There is an internal telephone system enabling people to call carers and managers as required. An external telephone line can be installed on request. There are assisted spa baths on each floor and one spa bath per week is included in the care packages with a fee payable for those who do not have a care package. Staff training includes that related to the control of infection and staff were seen to be wearing gloves as required when delivering personal care however, whilst staff did not wear gloves and aprons when preparing breakfasts and this needs to be rectified to ensure good hygiene is practiced in respect of handling food. At the start of the visit one person was calling out and a visit to their room found that they did not have Care Homes for Older People Page 19 of 31 Evidence: access to a call bell and this needs to be addressed to ensure people can summon help when required. In addition, one person who was distressed was walking around the home was not wearing her alarm pendant and action needs to be taken to address this as she also needed to call out rather than be able to summon help. There are well maintained gardens to the side and rear of the building which are safe and fully accessible to people living in the home. The veranda areas are enclosed and used to grow edible herbs and flowers which are planted and tended by people living in the home as part of the activity programme. There are areas throughout the unit that include props such as clothes and jewelery that are designed to prompt discussion about individuals working lives although none were being used on the day it would appear that these could be used to stimulate good interaction between staff and individuals. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although staff training and recruitment is satisfactory additional staff need to be deployed to ensure the needs of people living in Sunrise are met and a plan be formulated to ensure 50 of care staff have National Vocational Qualification level 2 in care. Evidence: Information in the AQAA showed that regular staff meetings are conducted with minutes recorded and these are held collectively in the main office. There is a supervision system in place that provides staff with formal 1-1 sessions to ensure staff feel supported. There is a comprehensive staff induction programme in place that meets the Skills for Care Guidance. Staff training covers fire safety, manual handling, Safeguarding Adults, infection control, dementia care and medication. Discussion with the Executive Director found that the service is aware that current staffing levels are insufficient to meet the needs of all people living in the home. Further discussion found that staff have been recruited and been given mandatory training so they are ready to start but have yet to receive a full criminal records bureau check. The latest guidance is that if people are at risk staff may work without a criminal records bureau check if supervised but the service have decided not to follow the guidance at this time. Evidence in other parts of this report demonstrate the negative impact of staff shortages have on the care and supervision provided to people living in the home. The Care Homes for Older People Page 21 of 31 Evidence: recruitment records for the last three people to be recruited provided all the required information prior to employment. Information provided by the Executive Director showed that of the 17 care staff, 6 have at least National Vocational Qualification level 2 in care, therefore the service needs to address this to ensure at least 50 of care staff have this qualification. Care Homes for Older People Page 22 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All aspects of the welfare, safety and health of people living in the home are protected and promoted but improvements need to made to management to provide staff with clear direction and leadership. Evidence: Following the site visit the Executive Director confirmed that although family and staff are provided with the code for the key pad system, security measures are in place. This ensures visitors are requested to sign in and that the code is changed at least every three months but more often if necessary. The Registered Manager left recently and it was evident during the site visit that staff lacked leadership and direction and this needs to be addressed. A brief discussion with a maintenance person found that he is from other Sunrise service and was on site to assist with the development of a maintenance programme to ensure the home remains safe, comfortable and well maintained at all times. The home does not manage the monies of people living in the home, family or Care Homes for Older People Page 23 of 31 Evidence: solicitors do so on their behalf. Information in the AQAA and from the Executive Director found that quality monitoring is carried out by Sunrise head office with contribution from the Wellness Co-ordinator and other senior staff. Accident records are appropriately maintained and are collated by the Wellness Co-ordinator as part of the quality monitoring process to identify and reduce risks. The building fully conforms to the fire safety requirements and all staff are trained in fire safety, in addition to regular fire drills being carried out. Care Homes for Older People Page 24 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 That the Statement of Purpose be amended to clarify action in the event of a service user disagreeing with assessments. To ensure service users are clear as to what action may be necessary in the event of a dispute. 20/10/2008 2 3 14 That the pre-admission document be expanded to include all care needs and how the service will meet identified needs. To demonstrate that the home can meet the needs of people living in Sunrise. 20/09/2008 3 7 15 That care plans be regularly reviewed and that service users or their representatives are involved in the reviews. 30/09/2008 Care Homes for Older People Page 26 of 31 To ensure service users and their representatives are aware of the contents of the care plans. 4 7 13 That care plans are fully completed and include direction to staff on meeting care needs. To ensure all needs are identified and met by care staff. 5 7 13 That detailed risk assessments for manual handling, falls and tissue breakdown be carried out and include information on the management and reduction of risk. To ensure staff are clear on what action to take to reduce risk of harm to service users. 6 7 15 That care plans are consistent with other information such as that in the 24 hour care summary and personal profiles. To ensure staff are able to deliver consistent care in a manner chosen by the service user. 7 8 12 That care plans inlcude detailed information on healthcare needs, such as opticians, dentists and chirpody and how they will be met. 30/09/2008 30/09/2008 30/09/2008 30/09/2008 Care Homes for Older People Page 27 of 31 To ensure service users healthcare needs are identified and met. 8 8 12 That care plans include 30/09/2008 information on action to take when people are noted to have lost weight. To ensure service users maintain a healthy weight. 9 9 13 Service users must not be left without access to medication prescribed for them therefore systems must be put in place to ensure that medication is ordered and received at appropriate times. To ensure service users always have access to prescribed medication. 10 9 13 That the method of measuring medication be reviewed to ensure double dispensing and loss of medicine does not happen. To ensure a clear audit trail can be maintained and the margin for error be reduced. 11 9 12 That pain relief medication is 30/09/2008 given at the required time. To ensure service users are not in pain. 12 9 18 That staff managing medicines are appropriately trained and competence skills assessed. 30/10/2008 30/09/2008 15/09/2008 Care Homes for Older People Page 28 of 31 To reduce the number of errors in the medication practice. 13 9 13 That medication records are clear, accurate and up to date. To ensure it is clear whether or not medication has been administered. 14 14 12 That staff adhere to service users preferred terms of address and their dignity is respected at all times. To ensure service users dignity and autonomy is respected and promoted. 15 22 16 That call bells are accessible to service users at all times. To enable service users to summon help when required. 16 26 16 That staff wear gloves and aprons when handling or preparing food. To reduce the spread of infection and food contamination. 17 27 18 That sufficient staff be employed based on service users dependency levels. To ensure service users needs are met in full. 18 28 18 That action is taken to ensure 50 of care staff have at least National Vocational Qualification in care at level 2. 30/12/2008 30/09/2008 30/09/2008 30/09/2008 30/09/2008 30/09/2008 Care Homes for Older People Page 29 of 31 To ensure staff have the skills to deliver good care. 19 31 8 That a suitably qualified and experienced person be recruited to manage the home. To provide staff with leadership and direction. 30/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 9 22 Photographs of service users should be signed and dated. That care plans include prompts for staff to remind service users to wear alarm pendants. Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - 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!