Inspection on 11/11/08 for Sussex Clinic

This inspection was carried out on 11th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sussex Clinic 20/11/07

Sussex Clinic 20/11/06

Sussex Clinic 11/01/06

Sussex Clinic 17/08/05

Sussex Clinic 05/10/04

Sussex Clinic 06/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

Thorndene

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sussex Clinic 44-48 Shelley Road Worthing West Sussex BN11 4BX     The quality rating for this care home is:   two star good 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: Ann Peace     Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Sussex Clinic 44-48 Shelley Road Worthing West Sussex BN11 4BX 01903239822 01903249997 carolassadi@ashbourne-group.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sussex Clinic Limited Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: A maximum of 25 services users who require nursing care may be accommodated. Of whom 6 may have a Physical Disability (PD) and (PD)(E). Date of last inspection Brief description of the care home Sussex Clinic is a detached; two-storey building that was once previously registered as a private hospital. It is situated approximately 1/4 of a mile from the centre of Worthing town with all its amenities and is near the sea front. It is privately owned and provides residential and nursing care for up to forty residents in the category of Older Persons. Within those registered beds is a provision for up to six persons under the age of 65yrs with a physical disability. Accommodation is provided in twenty-four single and nine double rooms. Seven of the single rooms and six of the double rooms have en-suite facilities. The rooms are arranged on two floors with a lift giving access to all but those on the mezzanine floor. Two lounges and a separate dining room provide the communal space. There is a generous parking area to the front of the building and a Care Homes for Older People Page 4 of 29 Over 65 40 0 Brief description of the care home secluded and well-tended garden to the rear, which is suitable for wheelchair users. Mrs Manejeh Shoai - Naini represents Sussex Care Ltd as the responsible person. The Registered Managers post is currently vacant. The fees range from 331 punds per week to 650 pounds per week. The current fees vary from between 331.00 to 600.00 pounds per week. Care Homes for Older People Page 5 of 29 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: two star good 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 two stars. This means that the people who use the service experience good quality outcomes. A visit to the home was made on 11th November 2008 by Mrs A Peace Regulatory Inspector. The previous visit to the home was in November 2007. The Annual Quality Assurance Assessment (AQAA) completed by the home was returned in good time for it to inform this inspection and gave us information about how the home has been performing since the last inspection. During the visit we met people in the communal areas of the home and in their bedrooms, we spoke to as many residents and their visitors as we could and observed Care Homes for Older People Page 6 of 29 staff and residents interactions throughout the visit. We observed residents to be comfortable, relaxed and content in the home and had good relationships with the staff who were looking after them. Residents told us and surveys indicated that residents are well looked after in the home by a caring team of staff. The majority of the surveys returned to CSCI were positive about the home and the staff, where concerns were raised in one survey these were discussed with Mrs Shoai at the conclusion of the visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Care Homes for Older People Page 9 of 29 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 10 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents of the service have the opportunity to make a fully informed choice about whether or not the home is suitable and able to meet the individual persons needs. Evidence: The home has a statement of purpose and service users guide which is available to anyone interested in moving into the home. The majority of surveys indicated and residents told us during the visit that they had been given sufficient information about the home to be able to make sure that it was the right place for them. Staff said that they are given up to date information about residents to be able to look after them the way they would wish. Care records examined during this visit were seen to have assessments and risk assessments carried out and all had care plans produced from these assessments. Care Homes for Older People Page 11 of 29 Evidence: All prospective residents are fully assessed by a qualified nurse to ensure the home will be able to meet their needs. The majority had been updated on a regular basis to show any changing needs of residents. Intermediate care is not provided at the home although the home does offer respite care. Care Homes for Older People Page 12 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of care plans do give clear information to assist with all aspects of health and personal care needs, so that the changing needs of residents living at the home can be monitored. Polices and procedures are in place for the safe administration of medicines. Residents privacy and dignity is respected and at the end of their lives they and their relatives would be treated with care, sensitivity and respect. Some of the recording in the care records is not up to standard and residents should have person centered social care plans to identify any social care needs that need to be met. Evidence: All residents living in the home have a care plan which has been developed from an assessment of need. The majority but not all gave clear information about the needs of the residents health and personal care needs. Individual risk assessments are in place for example, prevention of falls and prevention of pressure sores. Two residents had Care Homes for Older People Page 13 of 29 Evidence: risk assessments for pressure area care which recorded they were completed on the same day but contradicted each other with different risk factors. We were told that they they were sure that the risk assessments had been updated at different times but mistakenly dated as the same date. Bedsides agreements have been signed for and risk assessments are in place. In two cases although broken areas to the skin of residents had been reported, recorded and dealt with appropriately, the body charts in the care records had not been updated. We were told that body charts are completed on admission as a baseline, The nurse in charge was advised that it would be good practice to update the body chart on a regular basis and any changes noted, so residents skin condition can be monitored. The majority of care plans but not all are updated on a monthly basis and did show the changing needs of residents, although the AQAA completed by the home clearly stated that all care plans are reviewed at least once a month. Nutritional risk assessments are carried out and monitored for some residents but not all. The nurse in charge was reminded that all residents admitted to the home must have a nutritional risk assessment and these should be monitored and updated regularly. When the AQAA was completed a section for these standards What we could do better was left blank. Mrs Shoai and the nurse in charge were advised to access the CSCI professional website and look at the document which offers advice on quality ratings and how homes could improve. We could confirm that residents health and welfare is monitored and that staff do respond when needed. We saw evidence where night staff had requested that pain relief be reviewed for one residents and the next day the day staff had requested a visit from the GP. The home has medication policies and procedures on the receipt, storage, handling, administration and disposal of medicines. Although the medication administration round was not observed during the visit a random inspection of the controlled drugs was carried out and these were in order. Medication records and storage were also examined and found to be in order. Qualified nurses administer medication and have regular training updates. The home does not use a recognized tool for end of life care but told us in the AQAA that staff work with other health professionals to ensure residents wishes are carried out. Basic records are kept of residents wishes at the time of their death and from what residents and their relatives told us and by observing staff we concluded that at Care Homes for Older People Page 14 of 29 Evidence: the time of their death, residents would be treated with care, sensitivity and respect. Some comments from residents and relatives were: Staff could not look after me any better. Staff are friendly and caring and listen to what I say. Staff look after my relative very well and always make me feel welcome. Pleasant caring and helpful staff. One survey although in the main positive, did raise one concern and this was discussed with Mrs Shoai and handed over to her to investigate and deal with if necessary. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some activities are offered at the home, however these could be more individual and person centered. Residents are encouraged to maintain contact with family and friends and they are encouraged to exercise choice and control over their lives. The choice and quality of meals served at the home has improved and residents say they are now happy with what is offered. Evidence: Those residents we spoke to during the visit thought that the routines of the home were flexible and they could make choices about how they spend their day. Most residents either stay in their bedrooms at their wish, some residents watch the television in one of the lounges and one residents goes out almost every day. There are no planned activities in the home and the home does not employ an activity co-coordinator, although sessions such as music for health and some entertainment is provided. There is a Christmas party advertised which is planned for December. The AQAA completed by the home stated that staff get information about the residents Care Homes for Older People Page 16 of 29 Evidence: past history, interests and hobbies but there was little evidence of this in the records. The AQAA did say that the home could improve by increasing the daily recreational activities and that they plan to provide individual outings and shopping trips over the coming year. Mrs Shoai and the nurse on duty were told that if group activities are not suited to the residents presently accommodated then individual person centered activities should be provided. This would mean that staff would need to find out about the residents previous lifestyle including interest and hobbies to ensure social needs are met. A survey completed by a relative did say that the home could be improved by having a designated person not on the carers rota to go around the rooms during the day and talk to residents as care staff do not have the time for socializing. Another relatives surveys said that more one to one social care should be provided. This section should be addressed in the next quality assurance survey that the home undertakes by asking what the residents want. The AQAA stated that the catering manager goes around and speaks to residents, but some residents told us that they never see the catering manager. The catering manager came to see us at the home and this and the meals were discussed. We were told and were shown a new menu with a lots more choice for residents. The catering manager said he only speak to residents as and when he sees them so the AQAA was not correct. He did say that he would implement a system whereby all residents were spoken with by catering staff on a regular basis to gain their views of the food served and this would be recorded. Records of meals taken by residents are not routinely kept but we were told that they would be in the future. Mrs Shoai told us that if relatives want to have a meal in the home they are welcome to and a visitor confirmed this. Since the surveys were completed and returned to CSCI the menus have changed to give more choice, and on the day of the visit the majority of the residents were complimentary about the food now served and said it had recently got better. We joined the residents in the dining room for the midday meal and tasted the sausage pie, mashed potatoes and mixed vegetable. The meal was tasty and well presented and residents looked as if they were enjoying their meals. There were alternative meals available and one resident who had changed her mind about what she had ordered was able to have an alternative. Care Homes for Older People Page 17 of 29 Evidence: Staff were on hand to assist residents who needed help in a sensitive and discreet manner. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaint procedure enables those people using the service to know that any complaints will be taken seriously and responded to. Residents living at the home are protected by the homes safeguarding adults procedures. Residents legal rights are protected. Evidence: The home has a complaint procedure and a notice of this is displayed in the home. Complaints are fully recorded and we could see had been dealt with in in with the homes procedure. Outcomes are also recorded although in one case the section had not been completed. Mrs Shoai explained that this was because of a confidentiality issue but was advised to put this in as an explanation so that it can be audited without disclosing and confidential information. There is a 24 hour on call service for residents and their relatives if they have any problems and details are displayed in the hallway of the home. Staff receive training in safeguarding adults procedures and when staff were asked they could explain the procedure, overseas ancillary staff who do not have English as a first language have had an interpretor to explain the procedure to them and records of this were seen. When residents were asked they did say that they felt safe in the home. Care Homes for Older People Page 19 of 29 Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, safe adequately maintained and offers residents a comfortable environment to live in. Evidence: Accommodation is on two floors serviced by a passenger lift. There is a mezzanine floor which is not occupied at present as there are a few steps down to it so any residents would have to be mobile and able to manage the steps. During the visit all areas visited were clean and furnished in a homely fashion although some areas are in need of re painting and decoration . Mrs Shoai told us that they are planning to start re decorating at the home in the near future. Residents told us that they are happy with their accommodation and their bedrooms showed that they have been able to personalize them with small items of furniture, pictures and other personal items to make them more homely. The group of homes that Sussex Clinic belongs to has a team of maintenance staff who can respond to emergencies, but who also carry out routine maintenance. On the day of the visit the water system was being tested to ensure it was safe. Maintenance records were examined and we could evidence that safety checks are carried out on a Care Homes for Older People Page 21 of 29 Evidence: regular basis and that equipment is serviced regularly. The AQAA states that all hot water outlets are fitted with thermostatic valves to minimize the risk of accidents. Since the last inspection we are told that two bathrooms have been re furbished and two overhead hoists installed. There is a pleasant, safe, secure garden planted with trees, shrubs and grass to the rear of the property for the use of residents and there is also seating available. Car parking is available to the front of the home. Care Homes for Older People Page 22 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living at Sussex Clinic are protected by the recruitment procedures and staff receive appropriate training so they can meet the needs of people living at the home. Evidence: A staff rota was available in the home and staff on duty observed to be well organized and able to respond to the needs of the residents living at the home. In addition to qualified nurses and care staff there are cleaning staff, maintenance staff and kitchen staff. Residents and relatives spoke highly of the staff, they said they were caring and friendly and listened to and acted on what residents said. There were some positive comments in the surveys and these are recorded earlier in the report. One survey did highlight some concerns and these were discussed with Mrs Shoai who said she would look into it, although there had been no recent complaints and the survey was anonymous. The AQAA recorded that the majority of care staff had NVQ 2 or 3, however when we discussed this on the day of the visit only 40 of the care staff had achieved NVQ level 2 and above. Unfortunately the section What we could do better was again not completed, the need Care Homes for Older People Page 23 of 29 Evidence: for the home to recognize that improvements can always be made is discussed earlier in the report. Recruitment and training files were examined and in the majority of cases were in order although some training files were being updated so relevant information had to be obtained from head office. We could see that training is encouraged in the home and there are plans to access training for staff in Equality and Diversity and the Mental Capacity Act. Care Homes for Older People Page 24 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is presently being managed by a deputy manager and is run for the benefit of the residents who are safeguarded by the homes policies and procedures. Evidence: At present the home does not have a registered manager, the deputy manager was on a day off when we visited but did come into the home to see if she could assist in any way. Mrs Shoai told us that they do have a manager who will be applying to CSCI to be registered when they return from extended leave in December 2008. Surveys indicated and residents told us on the day that they thought the home was running well and that staff were well organized. Through observation and by speaking to residents, visitors and staff we concluded that the management approach in the home is open. Residents and their relatives said they would have no hesitation in speaking to staff or Mrs Shoai if they had a problem or a concern. Mrs Shoai carries out regular visits as required under Regulation 26 and Care Homes for Older People Page 25 of 29 Evidence: reports are prepared on the conduct of the home. These were available for inspection. There is a quality assurance system in operation but this does need to be extended to complete a full circle of self monitoring, based on seeking the views of residents and other stakeholders and audits to measure the homes success and identify where improvements can be made. The results of residents surveys should be published and made available to current residents, prospective residents and other interested parties. The home does not manage any money on behalf of the residents. There is a staff supervision and appraisal system in operation in the home and we were shown a dated timetable as evidence. In The majority of cases the record keeping in the home is up to standard but there were a few instances where records were contradictory or incomplete. This was discussed at the conclusion of the visit with Mrs Shoai and the nurse in charge. In the case of care records the record keeping does not reflect the good care that the residents say they receive so should be improved. They were also reminded that records for inspection should be available in the home. We were able to confirm that staff are trained in how to keep residents safe and that staff do follow health and safety procedures. Maintenance records were available to evidence safe procedures are being followed. Care Homes for Older People Page 26 of 29 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 27 of 29 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 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!