CARE HOMES FOR OLDER PEOPLE
Sussex Clinic 44-48 Shelley Road Worthing West Sussex BN11 4BX Lead Inspector
Gill Davis Announced 17 August 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Sussex Clinic Address 44-48 Shelley Road, Worthing, West Sussex, BN11 4BX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01903 239822 01903 249997 Sussex Clinic Ltd Mrs Elaine Bird CRH 40 Category(ies) of OP-40 registration, with number of places Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: A maximum of 25 service users who require nursing care may be accommodated. Of whom 6 may have a physical disability PD and PD(E) Date of last inspection 05/10/04 Brief Description of the Service: Sussex Clinic is an adapted, detached two-storey establishment that was previously registered as a private hospital. It is situated approximately ¼ mile from the centre of Worthing and all its amenities and ¼ mile from the sea front. It is a privately owned care establishment providing nursing care for up to forty service users in the category of Older Persons. Within these registered beds is a provision for six service users under the age of 65 yrs of age with a physical disability. Accommodation is provided in twenty-four single and nine double rooms. Four of the single rooms and one of the double rooms have en-suite facilities. The rooms are arranged on two floors with a lift giving access to all but two rooms. Two lounges and a separate dining room provide the communal space. There is a generous amount of parking space to the front of the building and a secluded and well tended garden to the rear, which is suitable for wheelchair users. Mrs Manijeh Shoai-Naini represents Sussex Care Limited as the responsible person. The registered manager, who had been the matron under the previous registering authority, is Mrs Elaine Baird, a Registered General Nurse. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 6 This was the first of the two inspections (minimum) that an inspector must make in a year. On this occasion this inspection was announced and took place over one day in August 2005. Prior to the inspection day the Manager had filled out a pre-inspection questionnaire and information from that has been used to inform this report. Comment cards were given to the home before the inspection to give to the residents and their relatives/visitors an opportunity to comment on their opinions of the care provided at Sussex Clinic and at the time of writing this report four had been received from relatives, four from residents. One relative’s card commented on the lack of communication and consultation regarding important matters concerning their relative/friend, however, on examination of a selection of residents’ care notes it was clearly stated when communication with relatives and significant others had taken place and it was apparent that this occurred on a regular basis. Four raised the need for more opportunities to bath often. On investigation, the care plans indicated that where a resident had requested a daily bath this was met and other records confirmed that this occurred. The other comment cards were very positive “ I am very satisfied at the way that my mother is looked after. She is always clean and the staff are most helpful” The aim of this inspection was to find out how the home cared for the residents and what the residents’ think of the service they receive. Prior to this date an early morning visit was made to the home in response to an anonymous complaint. Two inspectors found the home appropriately staffed and were able to observe the early morning routine, which was carried out in a calm and competent manner. The complaint was not substantiated apart from one issue regarding the heating, which was resolved at the time of the visit. A tour of the home was undertaken on the day of inspection. Staff members personal files and resident personal care records were inspected as well as the Home’s Statement of Purpose, Service Users Guide and some of the Policies and Procedures. It was observed that a copy of the Statement of Purpose and previous inspection report was available to all and displayed on the table in the hall entrance along with the signing in book. All of the staff on duty, and most of the residents were spoken to during the course of the inspection. The residents were of the opinion that the staff members were good at their job and looked after them well, “Most of the staff have a good sense of humour and they are definitely kind and compassionate” They also considered that the staff listened to their requests and respected them “They always knock on doors and wait for an answer ---- Mrs Shoai listens greatly and acts too” --------“More fruit was wanted and this request has been met, we now have plenty of fruit.” The food was considered to be good, “ The food is alright here, there are always several dishes to choose from”. There seemed to be a good atmosphere in the home and this impression was reinforced by the residents’ comments “There’s lots of joking and laughter with us all”. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 7 The staff group confirmed that they found the senior staff members supportive and that they were given enough information about the residents to be able to meet their emotional and physical needs. Throughout the inspection the Inspector was able to observe the interaction between staff members and residents, which was relaxed, good humoured and professional. What the service does well: What has improved since the last inspection?
Staffing levels have been enhanced by a recent recruitment drive. Some areas of the home have been redecorated and refurbished. A new ensuite shower has been provided to one resident. Policies and procedures have been updated. More fresh fruit has been introduced following a request from the residents. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1.3.4.5.6. All prospective residents, or their representatives, have a number of opportunities to make an informed choice about whether they want to live at Sussex Clinic and have their needs assessed prior to admission by a senior member of staff. Intermediate care is not provided at the home. EVIDENCE: The home provides a comprehensive Statement of Purpose and Service User Guide to all prospective residents, their families and their Care Managers. Everybody concerned with the prospective resident is encouraged to visit as often as they like and a four-week trial period is used to allow the new resident to settle in and make sure that they are happy with the situation. Most of the residents were very positive about their experiences when first moved into the home. Some were unable to speak to the inspector about their experiences on admission because their disability precluded it. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7.8.10. Where possible residents or their relatives/representatives are involved with the drawing up of their care plans, which contain detailed information of how the care and health needs of the residents should be met. All health needs are met. From evidence gathered it would appear that the staff group respect the privacy and dignity of the people living at Sussex Clinic. EVIDENCE: Residents are involved with the drawing up of a plan of their individual needs and preferences. Where a resident is not able to be involved with the drawing up of their care plans, then the residents relative or advocate is involved as far as possible. The care plans included up to date information regarding the residents’ current health status and had been reviewed on a monthly basis. Staff members with the appropriate skills are employed to ensure the health needs of the residents are fully met. Observation of care staff members interacting with the residents confirmed that they were respectful and considerate in their approaches to the residents. Some of the residents’ comments confirmed this view. “ They’re polite and treat me with respect they always knock on the door and wait for a reply”. “ They always take such care with the dressings on my leg and make sure I am in my room so that it can be done in private”
Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12.13.15. The residents are provided with some opportunities to follow their chosen lifestyle. Where the resident is unable to make those choices and decisions for themselves, family or representatives are consulted. A wholesome and balanced diet is provided. EVIDENCE: All preferences and interests are recorded on the care plans. The inspector witnessed staff members helping the residents who had memory loss to make choices that were within their capacities. Suitable activities are provided and the home provides a variety of activities during the week according to the preferences and abilities of the residents, although a large number of the residents are frail and incapacitated to a degree which prevents them participating in anything other than one to one activities. The position of the home enables those that are more mobile the opportunity to enjoy all the facilities of the centre of the town. Other entertainments are organised on a monthly or bi-monthly basis. The residents confirmed that they enjoyed the various activities arranged for them. The inspector joined the residents in the dining area for lunch. There were several choices at the mealtime and the residents confirmed that they had enjoyed their meals “ there is always a choice of several dishes for us to choose from”. During the meal the inspector was able to observe the care staff carrying out their duties in a discreet and dignified manner. One of the residents
Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 13 commented that staff members were scrupulous regarding the residents’ privacy and dignity and gave the example “ if anyone gets into trouble in the dining room the staff are very discreet and help the person out in a way that does not draw attention to them” Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16.18. The residents or their representatives are sure that they can trust the home to protect them as far as possible from bad practice and unacceptable behaviour from others. EVIDENCE: Most of the residents are able to complain and were aware of whom to complain to. The home has policies and procedures in place to ensure that action is taken if a resident or their representative was worried and records are maintained of any issue that might arise and the outcomes. A recent anonymous complaint to the Commission for Social Care Inspection was followed up at an early morning visit to the home. The majority of the allegations were not substantiated. The home has clear instructions for staff members as to what to do if abuse of a resident is suspected and the members of staff that were spoken to were knowledgeable about the procedure to take following recent training in the Protection of Vulnerable Adults. Ten personal files of staff members were scrutinised and all files showed that all the checks to ensure proper security screening had been carried out. Training records were kept on each individual’s file. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19.20.21.24.26. The home is well decorated and maintained to a good standard both inside and in the garden areas. It is furnished to a reasonable standard. Each resident has a room that has been furnished to meet their wishes and needs, and there are suitable washing facilities and lavatories. There was a good standard of cleanliness. EVIDENCE: During the course of the inspection the majority of rooms were visited to make sure that the environment was safe and comfortable for people who live there. The garden is level and well maintained. Wheelchair users are unable to access the chapel and garden from the rear exit door and the inspector recommended that a small ramp be provided to the interior lip of the door to enable wheelchair users to exit independently. It was seen that many residents had brought personal possessions into the home, including small items of furniture, ornaments and photographs. One resident had requested that a shower should replace the bath to allow for more independence and the registered provider had undertaken this. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 16 On the day of inspection, Sussex Clinic was clean, and free from offensive odours in all areas. Risk assessments regarding the safety of the building were in place. Policies and procedures were available for staff about the control of infection, and the safe disposal of clinical waste. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.29.30. Sussex Clinic has an adequate number of staff members with appropriate training and skills to provide competent care to the residents at all times. EVIDENCE: Some staffing difficulties had been experienced in the recent past but this has been resolved by the recruitment of additional staff members. The rota was examined and found to be satisfactory. A random selection of staff files was looked at including the most recently appointed member of staff. All the required security checks had been carried out and evidence of identity, immigration details, qualifications and training were also on file. Appropriate induction training had been undertaken with the newest members of staff. Some of the staff team have undertaken training in a number of work related topics. 30 of the non-qualified care staff has achieved National Vocational Qualification level II. Formal supervision of staff members is undertaken on a regular basis and minutes of those meeting are kept on file. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.34.35.37.38. The home is run in a manner that offers protection to most aspects of the residents’ interests. EVIDENCE: The Registered Manager of the home is a Registered General Nurse with many years experience of managing a Care Home and has all the skills and competence to discharge her responsibilities fully. Care staff members confirmed that they found the Manager and other senior staff very supportive and that they considered that they were given enough information about the residents to carry out their duties competently. There are comprehensive policies and procedures in place to provide protection to the residents and guidance to staff members on how to carry out their duties; records were found to be accurate and up to date. In particular the individual care plans contained vital information regarding the residents’ health and welfare needs and promote a uniform approach to the care and protection of the residents.
Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 19 The personal finances of the residents are managed by himself/herself or a representative and recorded appropriately. The health, safety and welfare of the residents are protected by the policies and procedures of the home. Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 x x 3 x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x 3 3 x 3 3 Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Sussex Clinic 20051027 H60-H11 S24221 Sussex CLinic V236449 170805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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