CARE HOMES FOR OLDER PEOPLE
Sutton Court Lodge 2 Chesterfield Road Brimington Chesterfield Derbyshire S43 1AD Lead Inspector
Jill Wells Unannounced Inspection 30th January 2006 02:00 X10015.doc Version 1.40 Page 1 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 Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 2 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. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sutton Court Lodge Address 2 Chesterfield Road Brimington Chesterfield Derbyshire S43 1AD (01246) 275703 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Derbyshire Care & Home Support Limited Mrs Patricia Ann Page Care Home 9 Category(ies) of Learning disability over 65 years of age (9) registration, with number of places Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the home be registered for one named service user under 65. Date of last inspection 28th September 2005 Brief Description of the Service: Sutton Court Lodge is registered to provide 9 places for residents over 65 with learning disabilities. The home is presently able to accommodate one name service user under 65. The home is a detached house in Brimington, which provides 5 single and two shared rooms. The home is on two floors and has a stair lift to support residents that have difficulty with the stairs. The home is maintained to a clean, comfortable and homely standard. The home is in the centre of Brimington Village close to shops and transport facilities. There are two bathrooms and three toilets, with appropriate grab rails in place to assist residents. There is a communal lounge and separate dining room area for residents to use. There is a loop system fitted in the lounge area for residents with a hearing aid. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over a 2.50 period. During this time five residents were spoken with. Time was spent with three staff that were on duty. Records were inspected including two residents’ files as part of the case tracking methods used. What the service does well: What has improved since the last inspection?
The service had attempted to meet the requirements made previously. Several requirements were almost met for example a medication trolley had been ordered, as had a fridge for storing medication. Completion of risk assessments had improved. Minor improvements to the environment including replacement of a damaged handrail and security of the laundry area had been met. Paper towels and soap dispensers had replaced communal soap bars and towels in toilet areas, which minimised the risk of cross infection. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 6 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. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 8 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 the following standard(s): 1 There was not all of the required information available for residents and prospective residents. EVIDENCE: The statement of purpose was checked. This document had been amended since the last inspection, although there were still minor amendments required for example it did not explain that the provider of the service was Derbyshire Care and Home Support, and did not name the responsible individual. It did not state that the service was for adults over 65 with a learning disability. The senior support worker was unable to find an updated service user guide. There was however a copy of the service user guide in one of the residents files. This had not been amended and still had the incorrect telephone number of CSCI. There had been no new residents since the last inspection. There were two vacancies at the home. These vacancies were in shared rooms. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7, 8, 9, 10 Although residents’ records were not of a good standard, there was evidence that residents’ healthcare needs were met. EVIDENCE: Two residents’ files were inspected as part of the case tracking methodology used. Although there was significant information within the files about each resident, there was not a clear care plan setting out the detail of how each individual’s needs will be met. The care plans seemed to focus on particular difficulties for example inflammation of feet and depression rather than needs, aspirations and goals. Records were generally in place concerning visits from doctors, chiropodists and dentists, although one resident’s record of chiropody visits was very out of date. The last record was March 2004. It was explained that this resident regularly attends the chiropodist and the daily records evidenced this. The optician record also did not include a visit that was made in 2005. One resident told the inspector that a staff member was taking them to have their hearing aid repaired the following day. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 10 The key worker was expected to write a monthly review. One file was up to date, however the second file had not had a monthly review since September 2004. There were daily records in place and evidence of a formal review that included a care manager from Social Services. Residents had risk assessments in place including outings, and undertaking bathing alone. Residents were supported to take responsible risks, and advice and guidance was given where appropriate. There was evidence in files that specialist healthcare professionals were involved as required. This included specialist community nurses and health advisors. Medication storage and administration was inspected. Records were kept of medicines received, administered and leaving the home. There were however gaps in medication administration records where staff had not initialled that they had administered medication. Staff confirmed that there was no procedure on how to respond when staff see a missing initial from the previous administering period. It was highlighted at the previous inspection that there was insufficient space for storing medication. It was stated that a medication trolley had been ordered and a lockable medication fridge was on order. Staff were not writing the date when medication had been opened when there was a 28 day discard period. It was therefore more difficult to ascertain whether the 28 day period had lapsed. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12, 13, 14, 15. Residents have opportunities for personal development and leisure activities. Residents were supported to be involved in the daily running of the home. EVIDENCE: Residents spoke about having opportunities to maintain and develop social and independent living skills. This included work undertaken at the Ability Centre. Residents that had attended on the day of the inspection had been taken to the pub by staff from the centre, which they enjoyed. One resident spoke about enjoying cooking whilst at the centre. There had been some improvement in the opportunities for residents to attend church. One resident spoke of attending the Faith and Light church, which they looked forward to. Residents were encouraged to pursue their own interests and hobbies. One resident enjoyed embroidery and several enjoyed knitting. One resident chose to spend most days in the town centre. Record showed that residents occasionally went shopping. DCHS provided a holiday allowance for each resident. Residents had requested that they have day trips rather than a full holiday this year. They were able to choose where they would like to go. This was discussed in residents meetings. Although residents take part in activities
Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 12 outside the home, staff were still concerned that residents needs were not always met due to staff numbers and difficulties with staff sickness(see Standard 33). Residents said that they could have visitors to the home if they wished to do so, or visit friends and family outside the home. Residents had freedom of movement around the home. They could spend as much time as they wished in their rooms. Each resident was offered the key to their bedroom door as well as a lockable facility. Residents were offered a varied diet. The week’s menu was planned in advance with involvement from residents. One resident said that, I like the food very much. Residents were encouraged to set the tables and be involved at mealtimes. There was a pleasant dining room area for residents to take meals in. There were records in place of meals that were taken. A requirement was made at the previous inspection that residents’ nutritional needs are assessed and regularly reviewed. Although the homes action plan stated that this had been undertaken, staff were unable to find a nutritional assessment for individuals. Weight was recorded and if any resident needed to lose weight for health reasons, they were supported and encouraged to do so. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 16,18 There were systems in place to encourage residents to make suggestions and complaints. EVIDENCE: There was a complaints procedure available in an appropriate format for residents. This explains how they could complain. This had been amended since the last inspection and now had the correct telephone number of CSCI, however the complaint procedure in individual residents files had not been amended. It was stated that there had been no complaints since the last inspection. There was evidence during the previous inspection that there were written procedures for responding to suspicion or evidence of abuse (including Whistle blowing) there was also a written policy and procedure concerning referral and checks of the protection of vulnerable adults (POVA) register. Some staff were still awaiting adult protection training. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 14 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 the following standard(s): EVIDENCE: The environment was not fully inspected on this occasion as at the previous inspection was found to be of a good standard. It was stated that the damaged handrail had been replaced and that the laundry was now secured. The requirement concerning covering radiators that had been assessed as a potential risk to residents had still not been met. It was stated that they were in the process of being made. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 15 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28. There were times when staffing did not meet the residents needs. EVIDENCE: During the day there was generally two staff on duty and one waking night staff. It was stated that there were occasionally three staff on duty in the day in order to meet social needs of residents. The previous two weeks rotas were checked. It was found that there were five morning shifts during this period that had three staff on duty. Staff spoken with felt that this was at times insufficient additional time to meet residents’ social needs. There continued to be two staff off sick on a long-term basis. Staff were working additional hours on a regular basis to cover the gaps in the rota. There were 16 staff working at the home. There were five staff that had completed or had started NVQ 2 or above. It was stated that staff were still waiting for places on NVQ courses. The requirement was for 50 of care staff to have undertaken or have commenced NVQ 2 Care by Dec 2005. All three staff spoken with were clearly very experienced and skilled in working with residents with a learning disability. There were no domestic staff employed at the home. Support staff would undertake all domestic duties including food preparation. This would place added pressure on the staff and reduce time spent with residents. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 16 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35. There was not a permanent manager at the home. There was no evidence that this was having an adverse affect on the home in the short term. EVIDENCE: Since the last inspection the manager had retired. The service provider had not informed CSCI office. It was stated that there was a temporary manager in place, although the details of this person had not been forwarded to CSCI. It was stated that DCHS were advertising for a new manager. The homes policies and practices regarding service users money and financial affairs were checked. Each resident had an individual bank account, and their personal allowance was deposited into this account. Staff support individuals to withdraw cash. The home had a safe system for storage of money, which included accurate recording sheets that were signed and checked and money
Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 17 kept in individual purses. Residents have a clothing allowance from DCHS. This is paid into their bank account twice a year. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 18 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X x STAFFING Standard No Score 27 2 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X x 2 Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes 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 OP1 Regulation 4 and 5 Requirement The statement of purpose and service user guide must be further revised. There must be adequate storage for all medicines. original timescale 30/11/05 When residents are prescribed medication that requires refrigeration, there must be a lockable fridge specifically for this purpose. Original timescale 30/12/05 There must be 50 care staff that have undertaken or have started the NVQ 2 Care qualification. Original timescale 31/12/05 There must be adequate staff on duty to meet the needs of service users including social needs. This may need a review of how staff hours are used. Original timescale 31/10/05 Radiators must be made safe in
DS0000020101.V281496.R01.S.doc Timescale for action 30/03/06 2. OP9 13(2) 30/04/06 3. OP9 13 (2) 30/03/06 4. OP28 18(1)(c) (i) 30/03/06 5. OP27 18 30/03/06 6. OP38 13(4) 30/11/05
Page 20 Sutton Court Lodge Version 5.1 areas where residents may be vulnerable. 7. OP9 13(2) There must be no gaps in 31/01/06 medication administration records. Staff must always initial that they have administered medication. There should be procedure to follow if staff notice a gap in the medication records. Each resident must have a clear 28/02/06 service user plan (care plan). The plan must set out in detail the action which needs to be taken by support staff to ensure that all aspects of the health, personal and social care needs of the residents are met. Each residents service user plan 28/02/06 must be reviewed on a monthly basis or as changes occur. All staff must undertake adult 30/05/06 protection training. The responsible individual must 14/02/06 formally write to CSCI informing them of the arrangements which have been made for the running of the care home in the absence of a permanent manager. This must include the name, address and qualifications of the person who is responsible for the care home. 8. OP7 15 9. 10. 11. OP7 OP18 OP31 15 13(6) 38 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 OP8 Good Practice Recommendations Nutritional screening should be undertaken for each resident.
DS0000020101.V281496.R01.S.doc Version 5.1 Page 21 Sutton Court Lodge 2. 3. OP9 OP7 Staff should record the date of opening medication when there is a discard period to ensure that the medication is discarded as required. Contact with health professionals including chiropodists and opticians should be recorded in the specific section of the residents file as well as in the daily records. Sutton Court Lodge DS0000020101.V281496.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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