Inspection on 29/04/09 for Sunrise Operations Edgbaston Ltd (Assisted Living)

This inspection was carried out on 29th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunrise Operations Edgbaston Ltd... 27/04/10

Sunrise Operations Edgbaston Ltd... 24/03/10

Sunrise Operations Edgbaston Ltd... 19/01/10

Sunrise Operations Edgbaston Ltd... 15/10/09

Sunrise Operations Edgbaston Ltd... 07/09/09

Sunrise Operations Edgbaston Ltd... 29/10/08

Extracts from inspection reports are licensed from CQC, this page was updated on 21/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunrise Operations Edgbaston Ltd (Assisted Living) 5 Church Road Edgbaston Birmingham B15 3SH     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: Yvette Delaney     Date: 2 9 0 4 2 0 0 9 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. that people have said are important to them: They reflect the things 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 35 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Sunrise Operations Edgbaston Ltd (Assisted Living) 5 Church Road Edgbaston Birmingham B15 3SH 01214551102 01214556689 Telephone number: Fax number: Email address: Provider web address: www.sunrise-care.co.uk Name of registered provider(s): Sunrise Operations Edgbaston Limited care home 68 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 68. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 68 Date of last inspection Brief description of the care home Sunrise Senior Living Edgbaston offers a purpose built care home for older people who require varied levels of support with day to day living (Assisted Living), nursing care and residential care. People can choose to live in the home for a short or long term stay. Care Homes for Older People Page 4 of 35 Over 65 68 0 2 9 1 0 2 0 0 8 Brief description of the care home Sunrise Assisted Living is registered to provide assisted living care with nursing for up to 68 older people. Assisted living care is provided on the ground and first floor of the premises. The home offers spacious accommodation within bedroom suites of varying sizes and layouts. Each suite provides a bedroom, living area and en suite facilities, which has a level floor access shower or a bath. Two separate spa baths are available for communal use. The home offers a luxurious, beautifully furnished and well maintained environment for people to live in. Two passenger lifts and staircase provides access to all floors in the home. There is a large lounge, restaurant style dining room and a well maintained kitchen. A charge is made for the bedroom suite accommodation £140 - £240 per day. An additional charge is made for a care package these prices range from £19 to £66.50 per day. Each additional hour of care is charged at £19. Additional charges are made for ironing services, care staff escort, chiropody, medication administration and weekly furniture rental. Care Homes for Older People Page 5 of 35 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: The quality rating for this service is 1 Star. This means that people who use the service experience adequate outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection focused on assessing the main Key Standards. As part of the inspection process we reviewed information about the home that is held on file by us, such as notifications of accidents, complaints, allegations and incidents. We gave some questionnaires out at the time of the inspection to both residents and their relatives. The deputy manager was also asked to give out questionnaires on our Care Homes for Older People Page 6 of 35 behalf to residents and their visitors/relatives. Twenty questionnaires were given out in total ten to residents and ten questionnaires to relatives. Seven residents and four relatives returned questionnaires. Case tracking involves looking at peoples care plans and health records and checking how their needs are met in practice. The inspection included meeting some of the people living at the home, including the five people whose care was being examined. Other peoples files were also looked at in part to verify the healthcare support being provided at the home. Discussions also took place with some of the residents and visitors to the home in addition to care staff and managers for the service. A number of records, such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. What the care home does well: What has improved since the last inspection? We found at this inspection that: Comprehensive pre-admission assessments had been carried out before people were offered a place in the home. This will support the home to confirm to prospective residents that they will be able to meet their care needs. Care plans examined show that they had been written to reflect the pre-admission assessments carried out by staff in the home before people are admitted to the home. This will ensure that people receive person centered care. Care plans had been written to identify the identified needs of people living in the home. This will help to make sure that people receive the care they need. Risk assessments had been completed for people who required the use of bedrails; these were seen to be well fitted to the beds. This will help to make sure that bedrails are used appropriately and residents are protected from possible injury. Advice from professionals on the care and treatment of residents living in the home had been documented and followed by staff. This helps to make sure staff have current information on the treatment and care residents must receive. Medication practices related to the requirements made at the inspection visit in October had been met. However there remain concerns about the standard of medication practices in the home. Care Homes for Older People Page 8 of 35 Recruitment procedures had improved and staff files organised to ensure they were easily accessible to identify that all appropriate security checks had been made. What they could do better: People living in the home told us what they thought the home could better. Their concerns were related to staffing and care delivery. Their comments are as followed: In telling us what the home could do better one resident gave us the letters T.L.C., which they refer to as Training, Leadership and Communication. Residents said that there is a lack of leadership and communication between staff and within their own departments. Too many agency staff that lack training and individual care needs. Improve care support services with less turnover of staff and more assistance available. Improve quality and quantity of care staff who should be permanent employees. Too many changes of staff both in management and care support workers. There has been too much reliance on agency staff, again no consistency. There has been insufficient care staff in the past. Residents felt that improvements need to be made in staffing saying that the staff changes have been upsetting to the staff and residents. Relatives and residents told us that the home could improve by being consistent with the care they give and sustaining a good standard at all times. A relative wrote in their questionnaire: We pay heavily for care support and do not get what is required. I tell the carers in charge of my mother, then for a few days I see an improvement, before care support returns to the lower normal level. Also the buck is passed onto others. Care support to be provided in a more timely manner. Care support is very hit and miss and not always done in a timely manner. Standard of care support needs to be improved and done consistently better. We made six requirements as a result of this inspection visit: The home must make sure that medicines are stored safely in the home. This will make sure that people are not put at the risk of harm. Medicines received in the home for residents must be commenced at the start of the 28 day cycle that they are prescribed for. This will make sure that people living in the home receive their medicines as prescribed for them. The home needs to make sure that all allegations or suspicions of abuse are appropriately managed and investigated to make sure people living in the home are Care Homes for Older People Page 9 of 35 protected from the risk of harm. Staffing levels in the home need to be reviewed to make sure there are sufficient numbers to provide care to residents when care staff are involved in non care duties. Staff in the home need to receive suitable training and complete a recognised qualification in care equivalent to NVQ level 2 or above. The home must make sure that we are notified of accidents or incidences, which must include any allegation of or suspected abuse. This will make sure that people in the home are protected from the risk of abuse and ensure appropriate action is taken. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 35 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 11 of 35 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. There is scope to develop information about the home further to make sure that full, accurate and up to date information is available to people who wish to use the service. People have the opportunity to visit the home before making the decision about where to live. People receive a comprehensive assessment of their care needs to ensure they can be met before admission to the home. Evidence: The Statement of Purpose for the home was read. Although reviewed and updated this year the document still does not make it clear how the Assisted Living and Nursing Neighbourhood section of the home will be operated and managed by nursing staff. For example reference to care services provided puts the responsibility of administering medication to people admitted for nursing care with the care managers. Related to staff competencies concerns were raised with the deputy manager and staff about the management of medication in the home, which are discussed under the health and personal care section of this report. At this inspection visit there were no Care Homes for Older People Page 12 of 35 Evidence: residents assessed and admitted for nursing care. A resident handbook and information guide is also available this gives a lot of information about the home and the services provided. The admission process was assessed at this inspection. A preadmission assessment form is available to support staff in making a comprehensive assessment of peoples needs before they are offered a place in the home. The form is detailed and if fully completed would provide a full assessment of the persons current needs, health and social history. The form guides staff on the risk assessments that need to be completed. All the information collected would support staff when developing care plans for people deciding to move into the home. It was noted that pre-admission assessments were not always fully completed for the three people followed through the case tracking process. Relatives and residents spoken with told us that staff had visited them from the home. In most cases they were able to tell us that this had been the manager and a nurse. They told us that they were asked a number of questions about their health, medical history, interests, and their family. All relatives had made a visit to the home before making the decision to use the home. One resident receiving respite care said that they liked the home as soon as they saw it. A further resident said in their questionnaire that their daughter had made the decision about using the home on their behalf. All residents living in the assisted living section of the home are privately funded. Therefore there was need for us to evidence assessments carried out by other professionals such as social workers or nurses from the local PCT. Two residents and a relative did comment that they would like to see a contract agreed between social services and the assisted living section of the home. Care Homes for Older People Page 13 of 35 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. Care files show improvement however, care plans are not consistently written and reviewed to clearly identify the individual care needs of all people living in the home. Staff do not follow safe medication practices at all times to make sure that the management and administration of medicines in the home is maintained at a safe level. Evidence: At this inspection visit the manager confirmed to us that they had not admitted anyone who required nursing care since their last inspection in October. The home plans to improve the service, which will include staffing, care plans, care planning and procedures in the home before resuming the admission of people requiring nursing care. We were told that residents requiring nursing support are followed up and attended to by district nurses. Care managers also ask the wellness nurse employed by the home who will make a referral to a GP. An Advanced Nurse Practitioner who has additional specialist skill to review the care of people living in the home and is qualified to prescribe certain medicines also visits the home. Care Homes for Older People Page 14 of 35 Evidence: At this inspection we examined the care files for five people living in the home. One of the residents had high dependency needs their care is supported by district nurses and a physiotherapist. People living in the home and their visitors were asked to share their experience of life in the home with us. Most people were positive about the care they received some concerns raised however were related to care not being given in a timely manner and sometimes having to wait. Moving and handling practices seen were carried out safely. Staff were observed using hoists, transferring residents from wheelchairs to armchairs and to the dining table. Equipment was available to help meet the needs of people living in the home. Residents were using pressure relieving cushions, mattresses, stools and the furniture was comfortable attractive and suitable for the people who use the service. Risk assessments tools are used in the home. Assessments carried out include the use of bed rails. Following our last inspection visit risk assessments had been completed before bedrails were used and appropriately fitted to beds. This means that staff had considered the best way of maintaining a persons safety while in bed. The five care files examined showed that some work had been carried out to improve them, however there were still some cause for concern in how care plans are documented. There were no residents requiring nursing care therefore care plans concentrated on identifying the personal and social care needs of the people living in the home. District nurses visit the home for those residents requiring nursing care and they maintain separate care plan documentation these are the property of the primary care trust (PCT). Of the five care plans examined one showed that it was appropriately and clearly written to identify specific care needs and the action staff need to take to meet these needs. The action staff should take to meet these needs was written in a person centred way. This means that they told us how the resident wanted and how they wanted their needs to be met based on an assessment of their needs and abilities. For example under social activities the plan for care said I have always loved horse racing, particularly the national hunt and love to watch horse and dog shows on the television. I love Crufts. A further care plan related to medication said I have always managed my own medication, but find it difficult now and will need to be assisted with this task. However, the guidance does not say what assistance or how staff should assist the person. The other care plans showed the identified needs to be the same as the plan of care. The identified goal/outcome written in the care plan did not make it clear what the Care Homes for Older People Page 15 of 35 Evidence: resident or staff were trying to achieve. For example I use a shower chair in my bathroom to enable my personal care routine to be done as safely as possible the goal was written as Risks of odours reduced. A further statement said I would like staff to ensure that I have my walking aid within easy reach at all times the goal stated here was To prevent me from having any unnecessary accidents from faulty equipment. This standard of documentation does not make it clear to staff the outcome they should expect from meeting residents care needs appropriately. Weight checks are carried out on residents; two people have treatment for diabetes. Records for one of the residents show that their blood sugar levels are monitored and the resident was able to continue to administer their own insulin. There are currently no residents with pressure sores. Staff were more informed about residents care needs at this visit and showed us that they were familiar and knowledgeable about people in their care. There would be concerns however on the ability of new staff or agency staff to meet the needs of people in the home if they are to rely on the information in the care plans. Daily reports written by staff on the document headed Daily Notes were not always written to be clear, accurate and logical, dated entries were mixed up. For example, one care plan had a date sequence of 28.4.09 the 29.4.09 then back to 28.4.09. A further care plan shows that a written entry dated 4.3.09 was written after the 7 April 2009. Staff did not always date, put an appropriate time or sign the written entries they had made with their full signature. Some days no entries were made and staff continue to scribble out spaces were staff had not written, which meant that staff started new daily notes sheets. Entries were also scribbled out. This did not make it easy to follow the day-to-day care given to residents while living in the home and highlighted a level of poor documentation. Daily entries that could be read and followed to map a resident daily life in the home gave an account of peoples health and state of well being while living in the home. One resident told us that the home could: Improve the care services with more consistency. We examined the systems for the management of medicines in the home. This was linked to the case tracking process by examining the medication administration records (MAR) charts for the five residents followed through the case tracking process. Medication and charts were looked at together with their care plans and daily records. Copies of the original prescription were available to check medicines against. However the medicines had not been accurately checked and recorded on the medicine charts Care Homes for Older People Page 16 of 35 Evidence: when staff started to use the drugs. Speaking to staff it was evident that medicines had been checked when they first arrived into the home. The medicines had not been checked in for residents to start using straight away. This would mean residents starting the 28-day cycle on different days. It was not possible to check medication balances against medicines administered because residents were still using medicines from the previous month or medicines that they had brought in. Some residents had commenced some of the new stock of medicines but there were no details of the amount received recorded on the MAR chart. Some medication charts had been hand written by staff but were not all complete with all the relevant details. For example the amount of drugs received and the date staff started to administer new medication making information recorded meaningless. A care manager involved in administering medicines to residents was spoken with during the inspection did not show that she had a good knowledge of the medication practises in the home. Medicines continue to be held in locked cabinets within a locked room upon receipt until they are required and then taken to each residents room were they are held in their own locked cabinet. Storage of all medicines was not good at this inspection. It was noted at this visit that the cabinet for storing medicines in one residents bedroom was not lockable because the lock had broken. This we were told had been like this for some time. One of the care managers told us that this had been reported to the maintenance man. The maintenance book was checked there was no information recorded to show that this had been reported or any work carried out to repair the lock. This had not been reported to the managers and it was not clear who checks and puts the medicines into residents cabinets. An immediate requirement was issued and we received confirmation at 09.30 the next morning (30/04/09) to tell us that the lock had been repaired and the other cabinets checked to make sure they were lockable and safe. One resident told us that they take their own medication as agreed between them and the home. A risk assessment had been completed and a self-administration medication policy/procedure is available in the home. This provides staff with guidance on the management and support of residents wishing to take their own medicines. Records available in the home show that audits of the medicines and charts had been carried out. These show that not all the medicines had been administered as prescribed at all times. Controlled drugs were safely stored in the home; these were checked with one of the care managers and the deputy manager. The balance was accurate with the stock available and the records maintained. Staff had a sensitive, kind and caring attitude towards the people living in the home. Personal care was provided in private, residents were spoken to respectfully by staff Care Homes for Older People Page 17 of 35 Evidence: and addressed by their preferred name. The activities coordinator for the home told us that when a resident dies they show their respect by lighting a candle during the day in the entrance area of the home. This is lit in remembrance of the person that has died. The candle is lit each day until the funeral has taken place. A special card is made and is signed by residents and staff to express their sympathy to family members. Care Homes for Older People Page 18 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are actively supported and encouraged to maintain their independence, interests, and take part in activities, which would enhance their quality of life. People benefit from a varied and nutritious diet in a comfortable and social environment. Evidence: The home continues to have a good programme of activities and events, which take place daily. The home has employed a new activity organiser and volunteers support her. The activity organiser told us that all volunteers undergo appropriate recruitment checks. A volunteer was visiting on the day of the inspection; she was sitting talking to a group of residents and making drinks for residents and guests. The volunteer told us that she visits one day per week. Residents were made aware of the activities that are taking place, notices are displayed around the home, activities and events can be changed to meet the needs of residents. At this visit some of the residents took part in a game, which involved passing a balloon to each other this provides physical stimulation for residents, some visitors and staff also took part. Some of the residents had also baked some cupcakes in the morning. Trips using the homes mini bus are planned weekly. Visits include weekly shopping trips and a trip out to a place of interest these include shopping in the city and a visit to Stratford butterfly farm. Care Homes for Older People Page 19 of 35 Evidence: Examples of other activities and events to promote socialisation and well being of residents include: skittles, morning coffee, newspaper discussion, crossword challenge and quiz nights. The activity organiser is planning to introduce Tai Chi for residents. Residents said that they are encouraged to take part but they make the choice. Weekly meetings are held with residents to help plan and provide activities and events they are interested in. Residents told us that they feel there is a good level of activities in the home, saying Activities excellent. A further resident commented, Better films for communal viewing and less background music. The home has an open visiting policy. People are encouraged to maintain links with their family and friends. Relatives told us that they are always made welcome the visitors book demonstrated that people visit when they want to. Families and friends were seen visiting the home throughout the day. A bistro area situated at the front of the home provides a small lounge area where residents and visitors sit together, make drinks and have snacks at any time. The dining room continues to present a comfortable and attractive dining area for people to eat. Residents told us that they enjoyed the food provided by the home. The inspector was invited to have supper with two of the residents. The food was well presented and tasty. The residents said they enjoyed the food and some meals had been prepared to help meet their West Indian tastes. Dining tables were properly laid with tablecloths, napkins, cutlery and condiments. A menu was available on the table and care staff asked residents for their meal choices when seated at the dining table. Residents were offered three course meals and a choice of soft drinks, wine, tea and coffee. Care staff and nurses acted as waitresses taking and writing down residents meal choices from the menu for the day and then giving them to kitchen staff. The menus for a four week period were examined these showed that meals were varied and offered residents a three course lunch each day in pleasant surroundings. Meals were delivered to people who chose to eat in their room. Residents made positive comments about the food provided in the home. The meals are varied and well balanced. Food is excellent. Good kitchen and dining room. Care Homes for Older People Page 20 of 35 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 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 the home can be confident that their concerns will be listened to. The standard of care delivery in the home does not show that people living in the home are protected from harm at all times. Evidence: A copy of the complaints procedure is displayed in the home and a copy is available in the statement of purpose this makes sure that it is accessible to people living in the home, their families and staff. Questionnaires returned to us from people living in the home and their relatives said that they would know who to speak to if they were not happy. People spoken with in the home told us that they find it easy to speak to the manager or staff on duty if they have any concerns. People generally felt that their complaints are listened to. There was some concern that issues are not always acted on promptly or fully addressed depending on who was dealing with the concern. Records are maintained of complaints and concerns received by the home. Information collated did not clearly demonstrate the action taken or contain sufficient information to show they were always responded to in a timely manner. We have not received any complaints about the Assisted Living with Nursing section of the home since the last inspection. The home however has one outstanding complaint raised before the last inspection in October 2008. We have been told that this complaint is in the process of being completed. The home has received four complaints since the last inspection three relating to missing money and one related Care Homes for Older People Page 21 of 35 Evidence: to a member of staff using a mobile phone while attending to a resident. The concern about the use of the phone has been resolved to the satisfaction of the resident. The other three complaints have not been resolved. The manager has advised us that these have been reported to the police. Feedback as to what progress has been made with these concerns was not available. The Home Manager has been asked to let us know in writing the present position with all outstanding complaints and the action being taken to resolve them. All residents are privately funded. The home has a policy for adult protection. The procedures give staff direction in how to respond to suspicion, allegations or incidents of abuse. Training records show that staff have received training in recognising signs and symptoms of abuse. However, the lack of action in dealing with concerns about residents missing money does not show that the home follows its adult protection policy. The current manager has informed us that they had been unaware that some of the complaints had not been fully followed through and has confirmed that they will be reviewed. Care Homes for Older People Page 22 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained providing a safe, attractive, homely and clean place for people to live. Evidence: Assisted living is provided on the ground and first floor of the home. Within this group of 58 residents the home is registered to provide assisted living with nursing care for up to 34 people. On the day of the inspection all residents were receiving assisted care. The facilities available show that the home is well equipped to help support their care needs. Four bedrooms were viewed, two shared rooms and one single room for people followed through the case tracking process and a further bedroom, which we were invited to see. All bedrooms were decorated and furnished to a very high standard. The shared rooms were spacious and suitably arranged. Bedrooms contained personal items to reflect the interests, age and gender of each person. The home is furnished to be easily accessible for the residents and there are a number of seating areas appropriately placed around the home making it easy for them to sit and rest if they want to. Bedroom facilities are designed as suites providing a choice of both single and double accommodation. The home was clean, fresh and well presented at this inspection visit. A relative in Care Homes for Older People Page 23 of 35 Evidence: their questionnaire told us in relation to the environment Better ventilation and more fresh air during the day in main sitting room would be appreciated. Residents have access to the laundry in the home where they can undertake their own personal laundry with support if needed. This practice helps to promote and maintain the independence of residents. Care staff and laundry staff undertake most of the remaining laundry in the home, which includes soiled laundry. Two of the residents told us of their concern about the standard of ironing carried out in the home. One resident showed us a pillowcase, which was poorly ironed. Their concern was that the standard of laundry had been poor for sometime. The laundry on the top floor of the home was viewed. This was spacious and contained equipment to meet the needs of the home. This includes two commercial washing machines and two commercial dryers. However the cover on the iron press in the home was in need of replacing. The pillowcase was shown to the deputy manager and the residents concerns discussed. The deputy manager assured us that she would address this matter. Systems are in place to manage the control of infection. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. The standard of food hygiene and cleanliness in the kitchen and restaurant area remains high. Cleaning records, fridge and freezer temperatures are maintained within the required range to store food appropriately and safely. Residents and relatives say that the home presents a cosy, comfortable and clean environment. Care Homes for Older People Page 24 of 35 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels in the home are not always sufficient to meet the needs of people living in the home. Residents cannot be sure that competent and qualified staff are caring them for. This means that the home cannot be sure that the needs of residents will be met safely at all times. Evidence: The home aims to provide one lead care manager (Lead care assistant) and four care managers (care assistant) from 7am to 3pm, one lead care manager and three care managers from 2.30pm to 10.30pm. One nurse is provided in the day between 7am and 3pm and one nurse at night with one carer from 10pm to 8am. Staff are employed to provide cooking and cleaning services to the home. The hours worked by the home manager, deputy manager and wellness nurses are not included on the duty rota. This does not demonstrate to us what the management or nursing hours provided in the home are. It was not clear from the duty rota that the home provides sufficient care staff. The home provides two staff at night for 34 residents. This is not sufficient to ensure that standards of care are consistently met and residents safety maintained at all times. Duty rotas show that a nurse is not on duty on all shifts and nurses are working in the capacity of a care manager. Care staff and nurses also undertake laundry and housekeeping duties, although Care Homes for Older People Page 25 of 35 Evidence: housekeepers are employed. This means that care hours are depleted when staff are taken away from meeting the care needs of people living in the home by spending undue lengths of time undertaking non-caring tasks. The duty rota does not show when staff are involved in housekeeping and laundry duties. Staff rotas show that agency staff covers some shifts when there is a shortage of staff. However some shifts were not always covered this could have an impact on the home being able to meet the care needs of residents. Residents told us that they felt staff are individually Friendly, efficient and very hard working. This person goes on to say: The staff changes have been upsetting to the staff and to the residents alike. We have suffered months of agency replacements seldom the same carer from one day to the next. We are now May 2009, fully staffed we are told up to Sunrise standards and ratio of staff to residents. Maybe if the disability of the latter were minimal. But we have an increasing number of severely disabled, wheel chair bound stroke victims, amputees requiring maximum care, time and labour consuming. The basic Sunrise policy of requiring care managers to combine the duties of medical, physical care and that of waitresses is quite impossible. There is no back up for holiday or sickness except for the dreaded agency staff. The manager told us that the staffing complement for the home is varied based on the needs of the people living in the home. The care manager is in charge of the shift delegates the work to staff on each shift. There are no residents admitted for nursing care. The manager for the home has told us there are plans to increase the number of nurses in the home. The home manager advises that they plan to start admitting nursing care residents and therefore will be recruiting nurses. The current system of working does not make it clear who is accountable to whom or clarify the role of nursing staff in the home. The personnel files of two of the most recent employed staff were examined. Files are organised, accessible and easy to follow. The files showed that they contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) had been carried out. The procedures in place ensure that recruitment procedures followed before staff start working in the home help to safeguard people living in the home from the risk of abuse. Information in the AQAA tells us that more than fifty percent of the staff have a National Vocational Qualification (NVQ) level 2 or above. However training information in the home and calculating the data in the AQAA shows that eight (27 percent) of the 29 care staff have NVQ level 2 qualifications in care. This could mean that people are not continuously cared for by trained and qualified staff. New staff receive a two week induction programme, which meets the National Minimum Standards described and Care Homes for Older People Page 26 of 35 Evidence: recommended by the skills for care council. Training records were available for examination. These showed that staff have received training in moving and handling however, training records show that staff are not up to date with other mandatory training required such as fire prevention and awareness, food hygiene, infection control and COSHH (Control of Substances Hazardous to Health). This will mean that staff are not up to date with safe working practices. Other training staff have attended include Alzheimers, dementia, activities, housekeeping and community relations. The training records do not show that care staff and nurses have received training relevant to the conditions and care needs that people admitted to the home present with. For example, there is no evidence to show that staff have received training in care of people with diabetes, strokes and prevention of pressure sores. Care Homes for Older People Page 27 of 35 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. The instability of the management structure within the home does not ensure that the service is run in the best interests of people living in the home. Evidence: The management arrangements in the home have been changed. The provider has not formally made us aware of these changes. The previous registered manager and deputy manager have recently left. A new manager has been appointed. The new manager started working in the home in March 2009 and has a lot of experience of working with older people. The manager previously managed another of the Sunrise Operations group homes. The management arrangements have not been made clear. There remains no clarification on the arrangements for providing a nurse staff structure in the home, which shows clearly the lines of management, supervision, accountability and responsibility if the home plans to admit people who require nursing care. Quality assurance checks are carried out in the home. Audits are carried out on the Care Homes for Older People Page 28 of 35 Evidence: services provided and identify areas for improvement. Residents and relatives meetings are held and the outcome used to support improvements in the home. The audits seen at this inspection was for the audit of medication practices. Medication management in the home showed some poor practices at this inspection. The outcomes of other audit checks carried out were not seen at this visit. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are available. The records of the four residents followed through the case tracking process where asked for. Monies and records available show that balances are accurate and auditing is regularly carried out. The certificate for the home was not displayed on the day of this inspection visit. This was discussed with the manager and action taken straight away. The certificate was displayed on a wall in the front entrance of the home at the time of the inspection making it clearly visible and accessible to residents, visitors to the home and staff. Records examined include maintenance, contracts and servicing documentation for electrical equipment, gas, clinical waste and all other services supplied to the home. Resident aids and equipment have also been serviced this includes hoists seen in use during the inspection visit. Concerns about us not receiving notifications related to adult protection as discussed under the Complaints and Protection of this report was discussed with the current manager for the home. The manager advised that she was not aware that we had not been notified as they had occured before she started working in the home. She had notified of two issues that had happened when she moved to the home. Health and safety concerns related to the use of bedrails had been addressed. We found that medication administration practices were still not consistently and safely managed in the home to show that the home is consistently being run in a way that protects people from the risk of harm. Care Homes for Older People Page 29 of 35 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 30 of 35 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 9 13 All dispensed medicines 30/06/2009 received into the home must be checked against the prescription and recorded onto the individual medicine charts of people living in the home. This must commence at the start of the 28 day cycle. This is to make sure residents have the correct medication at the start of the 28 day medicine cycle. 2 9 13 All medicine cupboards in the home must have an appropriate lock. This will ensure that all medicines are securely stored in the home. 30/06/2009 3 18 13 All allegations and incidences of abuse must be taken seriously by making sure that a timely and informed investigation can take place if appropriate. 31/05/2009 Care Homes for Older People Page 31 of 35 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 This will make sure that people feel confident that they are protected from the risk of abuse while living in the home. 4 27 18 Staffing levels must be 31/07/2009 reviewed to make sure that sufficient numbers are on duty at all times. This must include reviewing the times when care staff are involved in housekeeping, waitressing and laundry tasks. This will make sure that care hours for people living in the home are not depleted while staff undertake non care duties. 5 28 18 Work is needed to increase the number of care staff with a NVQ level 2 qualification or equivalent in care. This will make sure that people living in the home are cared for by competent and qualified staff. 6 37 37 Systems must be put into 29/05/2009 place to ensure that we are informed about incidents and accidents affecting the health, safety and wellbeing of people living in the home. This must include making us 31/07/2009 Care Homes for Older People Page 32 of 35 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 aware of any incidence of suspected or alleged abuse. This will help to make sure that people living in the home are protected from the risk of harm. 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 1 The home should make sure that the statement of purpose accurately reflects the services they offer, especially in relation to nursing care services. This will make sure people are fullt informed about the services available to them. Care plans must provide staff with clear guidance on the action they must take to meet the needs of people in their care. This will ensure that residents receive the care they need. Written entries in residents care files should be dated, timed, written in a logical format with no crossing out and signed with the signature of the person making the entry. This will help to ensure that a legible and effective audit trail is available to track the care given to people living in the home. Care plans must identify the individual care needs of people choosing to move into the home. This will make sure staff know the needs of people in their care. Complaints must be acknowledged and investigated in a timely manner. This will make sure that people feel confident that their complaints will be taken seriously. Equipment for the laundering of residents clothing should be maintained in good working order. This will help to make sure residents have their laundry returned to them clean and well ironed. Plans to increase the number of nurses working in the Page 33 of 35 2 7 3 7 4 7 5 16 6 26 7 27 Care Homes for Older People 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 home should continue if the provider intends to operate a care home with nursing. This will make sure that the home has suitably qualified staff working in the home. 8 30 A review of staff training needs should be carried out to make sure all staff have the appropriate skills, knowledge to provide care for people offered a place in the home. this will make sure that residents receive the right care and are cared for by competent staff. An appointed manager for the care home should forward an application to be considered for the role of Registered Manager for the home. This will help to make sure that people live in a home that led and managed in a way thta puts their best interests at the centre of the organisation. A clear structure should be in place to demonstrate the lines of accountability and responsibility of nurses and care managers working in the care home. This will bennefit residents to know and be clear about the individual roles of staff working in the home. Evidence should be available in the home to confirm that a robust quality assurance system is in place. This will support the home to monitor practices in the home and confirm that the home is being operated in the best interests of the people who live there. Medicine cupboards in residents bedrooms should be checked to make sure that they all have an appropriate lock fitted to make them secure and does not put anyone at risk from harm. 9 31 10 32 11 33 12 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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). 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