Inspection on 29/10/08 for Sunrise Operations Edgbaston Ltd (Assisted Living)

This inspection was carried out on 29th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 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... 29/04/09

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

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:   zero star poor 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 1 0 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. 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 36 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 36 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: Name of registered provider(s): Sunrise Operations Edgbaston Limited Name of registered manager (if applicable) Ms Joanne Anita Gordon 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. 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 Care Homes for Older People Page 4 of 36 0 Over 65 68 care home 68 Brief description of the care home 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 36 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: zero star poor 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 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 notification of accidents, complaints, allegations and incidents. The manager was asked to give questionnaires to the three residents followed through the case tracking process and their relatives. Case tracking involves looking at peoples care plans and health records and checking how their needs are met in practice. Three Care Homes for Older People Page 6 of 36 nurses were also asked to complete questionnaires. Only one completed questionnaire was returned by a resident giving their views of the service they receive. The inspection included meeting some of the people living at the home, including the three 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 took place with some of the people that live at 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? What they could do better: We made several requirements that the provider must comply with to improve the quality of outcomes for people using the service. All care files must record the clinical conditions of residents and show that an assessment has been carried out to identify their health care needs. This will help to support people to have all their care needs met. Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. This will make sure that people receive the care they need. Risk assessments must be carried out before bedrails are used for individual residents to make sure that they will keep them safe at all times. The risk assessment must include ensuring that they are appropriately fitted to the bed and therefore fit for purpose. The decision to use bedrails must be made in a timely manner. This practice will help to support the health and safety of people living in the home. Staff must make sure that the ongoing monitoring of residents health, which includes observations, recording the amount of fluid a person drinks or passes, turning residents to prevent pressure area damage is carried out, fully completed and recorded. This will mean that staff have the information they need to review the care of people living in the home and be able to meet their individual current care needs. Advice from professionals on the care and treatment of residents living in the home Care Homes for Older People Page 8 of 36 must be written into care plans so that staff have current information on the treatment and care residents must receive. There must always be sufficient and appropriate dressings in the home for the treatment of pressure sores. This will make sure that nurses are able to provide the right care and treatment that is prescribed for a resident at all times. The right medicine must be administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice. This is to ensure the health and well being of the service user is maintained. A system must be installed to check the prescription prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. This is to ensure that the service user has the correct medication to be administered. All dose regimes must be clearly written on the medicine chart as prescribed by the clinician, checked by a second member of staff for accuracy to ensure that the staff have clear directions to follow. This is to ensure that the service user is administered the correct current dose of medication. A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. This is to ensure that nursing staff administer the correct medication at all times and record accurately what they have done. All residents must be risk assessed as able to self administer their own medication and regular compliance checks must be undertaken and documented to ensure that they can handle their medication safely. All medication on the premises must be recorded. This is to make sure that residents receive their medication as prescribed. Staff must also be aware of the medication that has been prescribed for people in their care and be able to fully support the residents clinical needs. Nursing staff must ensure that people living in the home receive appropriate timely care and that thorough risk assessments are in place so that staff know how to support people living in the home. This will help to make sure that people are protected from the risk of harm. 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 Care Homes for Older People Page 9 of 36 240 7535. Care Homes for Older People Page 10 of 36 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 36 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. Standards 1 and 3 were assessed. Information about the home does not provide full details on the services the home provides. This does not ensure that people have current information about the home. People do not always 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 updated this year there was a lack of information on the nursing service that people with nursing needs could expect to receive if they were to move into the home. A resident handbook and information guide is also available this gives a lot of information about the home and the services provided. However, the handbook also gave limited details about what nursing care services are provided to people with nursing needs. The admission Care Homes for Older People Page 12 of 36 Evidence: process was assessed at this inspection. A form has been developed this shows the areas to be assessed at the assessment. 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. One of the residents was able to tell us that they had a visit from 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. The manager said that it was procedure for her and the Wellness nurse to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. There are opportunities for prospective residents or their representatives to visit the home before moving in. One resident told us, I visited the home with my daughter before I moved in. It was lively and welcoming. Care Homes for Older People Page 13 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10 were assessed. The healthcare needs have not been identified for all residents, which means that people living in the home do not receive appropriate care at all times. Evidence: At this inspection we examined the care files for the three people living in the home who have been assessed as having nursing needs. Two of the residents had high dependency needs, this is referred to as Nursing by the home. We asked some of the people who live in the home about their experiences. Two of the residents followed through the case tracking process were unable to tell us about their experience of the service due to limited speech and or confusion. To support our evidence on the care people received the interaction between staff and residents were observed. One resident spoken with said that the care they received was good sometimes. In other comments we were told that staff were not always available when the residents needed them. A further resident said in their questionnaire There is always someone Care Homes for Older People Page 14 of 36 Evidence: available. Moving and handling practices were noted to be carried out safely. Two staff were observed using a hoist to transfer a resident from the chair to the bed. The resident being helped to bed was being nursed in a specialist nursing bed. A pressure relieving mattress was also in use. Risk assessments tools are used in the home. Assessments carried out include the use of bed rails. One of the residents case tracked was continually falling out of bed. This was first noted by staff on the 30/09/08 when staff wrote found on the floor rolled out of bed, needs to be assessed for bed rails and bumpers. It was not until nine days later 9/10/08 when staff wrote bed rails now in position. A visit to the residents bedroom showed that there were gaps around the sides and top of the mattress, which could present a risk of entrapment for the resident. Written information in daily records told us of an occasion 13/10/08 when staff wrote that the resident was found with his head stuck between the bed and bed rails. There was no evidence to show that a risk assessment had been carried out before the bed rails were used or the action taken after the resident was found to prevent this happening again. This means that staff had not given consideration to the best way of maintaining this persons safety. Although the three residents followed through the case tracking process were considered to need nursing care the manager who is not a nurse told us that all care plans are written by her. The identified needs of the residents covered areas such as social and personal care needs. There are nurses working in the care home but the only clinical area identified in care plans examined were related to the care of pressure sores. Care plans were poor in that they did not record all the clinical needs of residents. This would mean that staff do not have good access to information about the health care needs of people living in the home and the actions they need to take to meet those needs. For example, staff identified during a residents stay that they had severe swelling of one of their legs. There was no evidence to show that the resident was referred for medical advice and a care plan was not developed to monitor or minimise their symptoms or discomfort. This puts this person at risk of deterioration in their health and well being. Records for one resident showed that the amount of fluid they were drinking and passing out of their body was not regularly recorded. Records examined also demonstrate that staff did not act on the outcome of the recordings made. The persons urine was dark in colour and they had passed a small amount of urine over 24 hour periods, which was not a good sign. Action was taken following a visit by the tissue viability nurse who advised that the GP should be contacted. The GP visited on Care Homes for Older People Page 15 of 36 Evidence: the day of the inspection and the resident was commenced on antibiotics. Other shortfalls were identified in the way the service manages people at risk of developing pressure sores. For example, the care plan for one resident with a high risk stated that 2 hourly repositioning was necessary. Turning records were maintained these showed that the frequency of which the resident was repositioned varied. Records showed intervals of two, three or four hours. We asked a member of staff about the frequency of repositioning for this person. The staff member told us, that it can vary at times. The failure of staff to follow written direction about the frequency of repositioning leaves this person at increased risk of an oversight of care. Separate records for wound care are written, these show that they are usually completed by nursing staff following a risk assessment of the persons skin condition. One of the care plans examined show that recent advice given by the tissue viability nurse on the treatment to be delivered to a resident with pressure sores had not been updated in their care plan. Wound care plans should be reviewed so that clear instructions are available for staff about the actions they need to take to treat the wounds. Details in daily records show that the residents wounds could not be redressed because the home ran out of the recommended dressings. The home provides a Wellness Nurse where people who live in the home can attend the wellness surgery in the Community The care provider prefers to call the home a community. Staff can also make referrals if they are concerned about the well being of a resident. Care files and talking to residents confirmed that people were visited by a Chiropodist, Dentist and Specialist Nurse. The home has access to two GP surgeries that provide a service to the home. Residents are also encouraged to keep their own GP. Daily reports in one of the care files showed that on some occasions daily reports were not written in a logical order and dated entries were mixed up. This did not make it easy to follow the day to day care given to this person while living in the home. Staff did not always date, time or sign the written entries they had made with their full signature. This would mean that the an effective audit trail would not be available to monitor the care given to people living in the home. We examined the systems for the management of medicines in the home. The pharmacist inspection lasted three hours. Four residents medication and charts were looked at together with their care plans and daily records. All feedback was given to the acting manager Bev Turner and Michelle Rushman. The medicines had not been accurately checked in this cycle as there were no copies of Care Homes for Older People Page 16 of 36 Evidence: the original prescription to check them in against. We, the commission were assured that this was to be addressed for the following 28 day cycle. Storage of medicines was good. All medicines were 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. Concern was raised that medication for another residential unit was also held in this room. This was to be addressed following this inspection. Two doctors practices are used together with two pharmacies, one of which does not supply computer printed medicine charts. These had been hand written by staff and seen to be well written for this cycle. All the relevant details had been recorded. Previous charts found and examined were poor and did not, for example record the date of administration so all information recorded was meaningless. Audits of the medicines and charts indicated that not all the medicines had been administered as prescribed at all times. Medicines had been recorded as administered when they had not been and some medicines were unaccounted for. One gap was seen and from audits this medication had not been administered and the reason for non administration not recorded. Staff have worked hard to correct the errors generated by poor ordering and also audits all the medicines on a weekly basis in the home. This system is time consuming and does not identify individual staff practice but has helped to address some of the errors. Concern was raised that one medication dose change initiated by a consultant had not been implemented resulting in the resident not receiving the correct dose of medicine. This error was compounded by staff not administering the dose recorded on the medicine chart and the resident received a third of the prescribed dose for seven days, which would be detrimental to their health and well being. Residents are fully encouraged to self administer their own medication, but staff do not risk assess that they are able to do this safely or undertake any compliance checks to demonstrate that they take them as prescribed . In addition there was no record of any of the medication these residents are prescribed and keep in the home. The Care Home Regulations 2001 clearly states that there must be a record of all medicines kept in the home for the resident so staff can fully support the residents at all times. One resident had been recorded as prompted only indicating that staff had not administered the medication. In conversation with the resident we were told that staff Care Homes for Older People Page 17 of 36 Evidence: had actually administered the medicines to her. We were told that staff did not sign to say that they had administered the medicines because they are unable to identify the medicines as they had been dispensed in a compliance aid. Nursing staff had not addressed this matter with the supplying pharmacist and obtained a supply that had been correctly labelled. Concern was raised that staff are not recording exactly what practice had occurred when administering medicines. The nurse spoken with during the inspection had a good knowledge of the residents clinical needs and knew what all the medicines were for and had challenged one doctor over the doses of two medicines that were high and not recommended by current medical guidelines. This particular matter was to be addressed following the inspection. 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 and addressed by their preferred names. Care Homes for Older People Page 18 of 36 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. Standards 12, 13, 14 and 15 were assessed. The lifestyle people experience in the home matches their preferences; they are supported to maintain their independence and enduring interests that enhances their quality of life. Residents benefit from a nutritious and varied diet. Evidence: The home has a programme of activities and events, which take place daily. Residents were made aware of the activities and notices are displayed around the home. At this visit there were no activities seen to take place. A weeks activity programme was read examples of activities and events to promote socialisation and wellbeing of residents include visits to Merry Hill for shopping, bridge, crossword challenge, movie nights and morning strolls. The activities take place over the course of the day. Programmes varied from week to week. Residents said that they are encouraged to take part but they make the choice. An activities coordinator is employed in the home. The activity programme shows that care staff play a big part in the daily delivery of the activity programme. Designated Care Homes for Older People Page 19 of 36 Evidence: care staff, separate to those providing care were not identified on the duty rota this leaves the risk of the number of staff being available to provide care being depleted. The home has an open visiting policy. People are encouraged to maintain links with their family and friends. Residents told us that visitors are made welcome and the visitors record demonstrated that people can visit when they want to. Families and friends were seen visiting the home throughout the day. A bistro area is situated at the front of the home in a small lounge area. Residents and visitors are able to make drinks and have snacks during the day and at any time. The lunchtime meal was served in the dining room. The meal was served directly from the kitchen which is situated next to the dining room. The dining area was well presented giving a restaurant style environment. A menu was available on the table and residents were asked by the care staff for their lunch choices when seated at the dining table. The meals for the day offered a choice of a starter, main course and desert. 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. The dining room was relaxed residents were having conversations with each other. The atmosphere was that of a social occasion. People eating said that they enjoyed their meals. Residents made positive comments about the food provided in the home. One person told us, the food is good, well cooked and presented. A resident said in their questionnaire that the meals are incredible fresh food, always a choice for each course. I have never had a poor meal. Care Homes for Older People Page 20 of 36 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. Standards 16 and 18 were assessed. 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 this makes sure that it is accessible to people living in the home, their families and staff. Comments in a questionnaire returned to us by a resident they said that they would know who to speak to if they were not happy. People spoken with in the home said that they would raise concerns with the manager or senior staff on duty. On the whole residents felt that their complaints are listened to, others thought that their concerns are not always fully addressed. Residents were observed to be familiar with staff on duty expressing confidence when making requests or raising concerns. We have received a number of complaints about services offered by the home since the the home was registered. Complaints have been received from family members and professionals. Complaints detail concerns about the poor standard of care, failure to implement treatment and poor management of residents resulting in deterioration in their health and wellbeing. We referred the concerns raised to the provider for investigation. A record of complaints and concerns received by the home is maintained along with Care Homes for Older People Page 21 of 36 Evidence: the action taken by the home regarding each issue raised. Evidence showed that complaints were not always responded to in a timely manner. The home has an adult protection policy to 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. The manager showed us through discussions that she is aware of her responsibilities in the event of suspected abuse. There was also an awareness of the role the local Social Services take if they receive allegations of abuse. Concerns expressed in the health and personal care section of this report does give concern about the safety and protection of residents in relation to the care they are receiving. There has been a number of safeguarding issues related to the care of people living in the home that have been brought to the attention of the local social services and ourselves about the home as a whole. There is currently one ongoing safeguarding investigation related to the Assisted Living Community taking place. This is being investigated by the local social services team. Care Homes for Older People Page 22 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 21, 23, 24 and 26 were assessed. 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 three residents in are receiving nursing care. On the day of the inspection the majority of residents were receiving assisted care with three residents assessed as needing nursing care. The facilities for these residents show that the home is well equipped to help support their care needs. The bedrooms of the three residents were decorated and furnished to a very high standard. This is in keeping with the rest of the home which presents as a comfortable homely hotel style environment. The home is furnished to be easily accessible to people living in the home. There are a number of seating areas appropriately placed around the home making it easy for residents to sit and rest if they want to. Bedroom facilities are designed as suites providing a choice of both single and double accommodation. All have a seating area, bedroom area, small kitchenette and spacious walk in shower. Viewing the bedrooms of the people involved in the case Care Homes for Older People Page 23 of 36 Evidence: tracking process showed that they are decorated to a high standard and reflect the individuality of the residents. Bedrooms contained personal items to reflect the interests, age and gender of each person. Residents also have the option to use the communal spa bath facilities. The standard of hygiene in the home was good the home was clean and fresh at the time of this inspection visit. 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. The remaining laundry in the home, which includes soiled laundry, is carried out by the care staff. Infrared motion sensors are fitted in communal toilets and bathrooms. These are designed to automatically turn on the lights when the rooms are entered. This aid means that residents can use the toilet independently. Push button locks are fitted to communal bathrooms and toilets. These can be overridden from the outside in the event of an emergency. Corridors are wide and easily accessible by all residents including those with mobility problems. People where observed moving around the home in wheelchairs and using walking sticks. Low wall rails provide hand rail support for residents as they move around. People living in the home have a choice of lounges and smaller seating areas. This encourages social interaction between residents. The lounges are decorated to be comfortable with appropriate furniture that meets the needs of people living in the home. There is a television in one of the lounges and satellite television is available for residents to enjoy. 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 was high and the staff should be commended for this. Care Homes for Older People Page 24 of 36 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. Standards 27, 28, 29 and 30 were assessed. Staffing levels in the home are not always sufficient to meet the needs of people living in the home. Residents benefit from being cared for by competent staff. People living in the home can not be confident that appropriate checks have been done to make sure that staff are suitable to care for them. Evidence: We were able to examine four weeks duty rota, three of which were working rotas. The duty rotas showed us that the number of staff on duty for each shift was not consistently maintained. Staffing levels in the home varied between four and six staff on an early shift, two of which were nurses. On the remaining two shifts there were three staff on a late and two staff on a night shift one of these staff would be a nurse. 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 number of staff on the late and night shift particularly causes concern as the current number of people living in the home requiring assisted living is 31. This means that on a late shift there is one member of staff to every ten residents, which includes the person in charge of the shift. On a night shift there would be one member of staff to every 15 residents, which again Care Homes for Older People Page 25 of 36 Evidence: includes the person in charge. The person in charge on each shift for the assisted living residents is not usually one of the nurses but one of the care managers (carers). The care manager in charge delegates the work to staff on each shift this includes allocating work to the nurses. This system of working does not make it clear who is accountable to whom or clarify the roles of each member of staff. The manager is supernumerary. Care staff and nurses also undertake some laundry duties, although house keepers are employed. This means that 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. Residents were heard to be very open in their discussions with a manager about their concerns about residents moving into the home being more dependent on the care staff. They said that there was not any more staff employed and staff seem to be involved in a lot of non care duties. Residents gave the example of care staff being waitresses at meal times. One resident told us, The staff are helpful sometimes as they are not always available straight away. Maintenance and administrative staff are employed in the home. The home has its own group of bank staff and at times agency staff are used to complement staff numbers. Staff rotas did not always show that agency or bank staff have been used where there is a shortage of staff. Training records show that over 50 percent of care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. Ongoing regular training is organised for staff. Staff were able to confirm training that they had attended. Records examined demonstrate that all staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. All new staff have an induction period. The induction programme for new staff is made up of nine days theory and a minimum of three days practical supervision. At this time staff told us that training covers health and safety and fire safety. During this time staff are also made aware of Sunrise policies and procedures and an introduction to the care of people living in the home. The personnel files of two recently recruited staff were examined and both contained evidence to show that pre-employment checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references were requested before staff started working in the home. However one file showed that the most appropriate reference had not been requested for a new employee. The most recent employers who could provide the most up to date information about this person had not been Care Homes for Older People Page 26 of 36 Evidence: approached. Robust recruitment practices support the safety of people living in the home from the risk of abuse. One recently employed nurse confirmed that pre employment checks were made before they started working in the home. Care Homes for Older People Page 27 of 36 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. 31, 33, 35 and 38 were assessed The home is managed by an experienced, competent person. Practices carried out in the home do not always ensure that the service is run in the best interests of people living in the home. Evidence: The registered manager for the home has recently left and the previous deputy manager has been appointed as the home manager. The manager has a lot of experience of working with older people. She is working towards the registered managers award, NVQ Level 4. The manager is supported by a nurse who has the title Head of Care whose role it is to lead on the care of the residents requiring nursing. It was not clear at this inspection visit that suitable arrangements are in place for the safe planning, management and delivery of care to people admitted to the home for Care Homes for Older People Page 28 of 36 Evidence: nursing care. This was further hindered by the lack of efficient and effective nurse staffing arrangements in relation to management, supervision, accountability and responsibility. Quality monitoring is undertaken by external managers and reports of their findings are available. Action plans are developed for making improvements and these are reviewed to monitor progress made by the home. Staff meetings are held and staff are given the opportunity to discuss areas to improve the running of the home. Residents and relatives meetings are held monthly discussions include activities that take place in the home, food provided in the home and planning menus. The home does not manage the personal monies of residents. Facilities are available for the safe keeping of monies and residents are told in the statement of purpose how much money they can keep in the home safe if they wish. An audit of one residents personal monies was found to be correct. Incidents and accidents that happen in the home are recorded and were available for examination. The maintenance man makes sure that equipment used in the home is serviced or tested as recommended by the manufacturer. Evidence was sampled at random to confirm this. For example, labels on fire extinguishes and hoists show the date they were checked and the date they are next due to be checked. Other servicing and checks carried out in the home include portable electrical appliances before they are used and water temperatures. Risk assessments and other work related to fire safety as requested by the fire service has been carried out. Records examined show that the fire alarm is serviced and is tested weekly. Standards of care discussed in this report under Health and personal Care do not confirm that safe practices are maintained to promote the health, safety and welfare of people living in the home. Practices evidenced related to the use of bedrails, medication administration practices and failure to consistently meet peoples care needs does not show that the home is being run in a way that protects them from the risk of harm. Care Homes for Older People Page 29 of 36 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 36 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 7 15 Care plans must be available 12/12/2008 for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must provide staff with information on how to meet the care needs of people living in the home. This will make sure that people receive the care they need. 2 7 15 Care plans must be written from comprehensive assessments of peoples needs. This will make sure that people receive person centered care. 12/12/2008 3 7 15 All care files must record the 12/12/2008 clinical conditions of residents and show that an assessment has been carried out to identify their health care needs. Page 31 of 36 Care Homes for Older People This will help to support people to have all their care needs met. 4 8 13 Advice from professionals on 12/12/2008 the care and treatment of residents living in the home must be written into care plans. This is so that staff have current information on the treatment and care residents must receive. 5 8 12 There must always be sufficient and appropriate dressings in the home for the treatment of pressure sores. This will make sure that nurses are able to provide the right care and treatment that is prescribed for a resident at all times. 6 8 12 Staff must make sure that the ongoing monitoring of residents health, which includes observations, recording the amount of fluid a person drinks or passes, turning residents to prevent pressure area damage is carried out, fully completed and recorded. This will mean that staff have the information they need to review the care of people living in the home and be able to meet their individual current care needs. 12/12/2008 12/12/2008 Care Homes for Older People Page 32 of 36 7 9 13 All residents must be risk assessed as able to self administer their own medication and regular compliance checks carried out and the outcome recorded. This will make sure that residents are able to manage their medication safely. 30/11/2008 8 9 13 All medication on the premises must be recorded. This is to make sure that residents receive their medication as prescribed and staff are aware of the medication that has been prescribed for people in their care and are able to support the residents clinical needs. 30/11/2008 9 18 13 Thorough risk assessments must be carried out and the outcome recorded to make sure that staff have sufficient and accurate information on the care, treatment and support residents must receive to meet all their care needs. This will make sure that people living in the home receive appropriate care which is based on a full assessment of their care needs. 30/11/2008 10 38 13 Risk assessments must be carried out before bedrails are used for individual residents to make sure that 28/11/2008 Care Homes for Older People Page 33 of 36 they will keep them safe at all times. The risk assessment must include ensuring that they are appropriately fitted to the bed and therefore fit for purpose. The decision to use bedrails must be made in a timely manner. This practice will help to support the health and safety of people living in the home. 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 Statement of Purpose and Service User Guide should be updated to reflect what services people admitted to the home for nursing care can expect to receive. This will make sure that prospective residents have current information available to them to help make a decision about using the home. A full and comprehensive assessment should be carried out before the person is offered a place in the home. This will support the home to confirm to prospective residents that the home will be able to meet their needs. Written entries in residents care files should be dated, timed and signed with the persons signature. This will make sure that a legible and effective audit trial is available to track the care given to people living in the home. Registered nursing staff should take the lead in assessing and developing a plan of care for people assessed as needing nursing care. This should help to make sure that all their clinical health care needs are identified and appropriate care plans written to meet their needs. The system for monitoring complaints should be reviewed to make sure that appropriate action is taken when complaints/concerns are raised with the home. Staffing levels should be reviewed to make sure that Page 34 of 36 2 3 3 7 4 7 5 16 6 27 Care Homes for Older People sufficient numbers are on duty at all times. Attention should be given to the numbers of staff on each shift and peak times of activity in the home. The number of staff on duty must be recorded on the duty rota and the rota kept up to date so it accurately reflects the staff working in the home. This will make sure that residents care needs can be met safely at all times. 7 29 Suitable and up to date information should be secured to determine the fitness of potential employees before they start working at the care home. This should include obtaining two written references, including where applicable, a reference relating to the persons last period of employment, which involved work with vulnerable adults. This will help to make sure that the homes staff recruitment practices safeguard people living in the home. Work should be undertaken to improve communication between staff working in the home to make sure that residents receive consistent quality care through the effective running of the home. A clear structure should be in place to demonstrate the lines of accountability and responsibility of nurses working in the care home. This will benefit residents by having staff working in the home who are clear about their role when delivering and managing their care. 8 31 9 32 Care Homes for Older People Page 35 of 36 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. 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