Inspection on 25/01/07 for Sutton Hall & Sutton Lodge

This inspection was carried out on 25th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sutton Hall & Sutton Lodge 08/07/08

Sutton Hall & Sutton Lodge 09/07/07

Sutton Hall & Sutton Lodge 07/09/06

Similar services:

Ravensworth Lodge

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sutton Hall & Sutton Lodge Bridge Road Mill Lane Sutton in Craven BD20 7ES Lead Inspector Caroline Long Key Unannounced Inspection 25th January 2007 09:30 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 Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 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 Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sutton Hall & Sutton Lodge Address Bridge Road Mill Lane Sutton in Craven BD20 7ES 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) 0113 3900522 0113 3900521 www.orchardcarehomes.com Orchard Care Homes.Com Ltd Care Home 60 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (40), Old age, not falling within any other of places category (20) Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users category DE and DE(E) to reside in Sutton Lodge. Service users in category OP to reside in Sutton Hall. Service users category DE to be aged 55 years and over. Date of last inspection 7th September 2006 Brief Description of the Service: The home, which was built in 2006, is split into two parts Sutton Lodge and Sutton Hall. The home is owned by Orchard Care Homes and is situated in Sutton in Craven on the outskirts of Crosshills. The home is accessible by local transport from Keighley and Skipton. Sutton Lodge is registered to provide nursing care for forty people from the age of fifty-five who have dementia. The home is on two floors with twenty ensuite bedrooms on each floor. The ground floor of Sutton Lodge has access to a conservatory and an enclosed garden. Sutton Hall is registered to provide nursing care for twenty older people who require nursing. The home is two on floors with ten en-suite bedrooms on each floor and a passenger lift. The ground floor of Sutton Hall has access to the gardens. The cost of a weeks care on 25th January 2007 was £530- £630 per week. There are extra costs for hairdressing, newspapers, chiropody and toiletries. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • • • • A review of the information held on the homes file since its last inspection. Information submitted by the Registered Provider in the Pre Inspection Questionnaire. Surveys received from three residents, thirteen relatives and three health professionals. An unannounced visit by two inspectors to the home lasting over seven hours. This visit included a tour of the premises, examination of records, talking to residents, care staff, a relative and a care manager and management. Two hours were spent observing the care being given to a small group of residents at Sutton Lodge. Looking at six residents care files in detail. • What the service does well: The home has a new manager and area manager, who are looking at ways of improving the service for residents. Relatives of the residents on Sutton Lodge made positive comments about the permanent staff team. The senior management have held relatives meetings. Where relatives have been able to raise any concerns they have about the care the residents receive and have been up dated about any improvements made to the home. In Sutton Lodge the communal seating areas have been increased. This has given the residents space to sit and talk privately with relatives. Relatives are welcomed into the home by staff, this enables the relatives and staff to build up good relationships which will help improve the care provided to the resident. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home was opened in April 2006, and has had difficulties in establishing a permanent staff team; this has lead to a number of areas where the home has found difficulty in meeting the National Minimum Standards for Care Homes for Older People. However, when the management have been made aware of the shortfalls they have taken actions to look at their practices and improve the services for the residents, but there are still some areas where little improvement has been made. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 7 The management need to look at ways of improving communication between staff to make sure they are all aware of how to provide the care the residents need to give them a good quality of life. Although the resident’s plans of care have improved, staff should be encouraged to use this information when they are providing care for the residents. Involvement of the allocated workers and the resident or their representatives may improve this. Well informed staff will improve quality of the health care the residents receive. Resident diets need to be looked at to make sure they are receiving and eating a nourishing diet, which will maintain their weight. The advice of a dietician should be sought about the types of diets, when and how the meals are offered to residents in the home. How medication is administered to residents should be reviewed to make sure that residents are receiving the correct dosage of medication at the correct times. Residents should be offered a programme of activities, to enable them to maintain their life skills. The management need to make sure all staff receive the training which is necessary for them to be able to care for all the residents needs, this must cover all mandatory courses, such as the protection of vulnerable adults, fire procedures, mobility assistance, and medication. Specialist training would also enhance the staffs’ ability to care for residents. The home’s staffing level must be reviewed to ensure that it is adequate to meet the needs of all of the residents at any time of the day and night. The staffing level must take into account the needs of the residents, the competence and experience of the staff and the layout and design of the premises. To improve the quality of the service the home provides, they should look at ways of improving their quality assurance systems. 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. The summary of this inspection report can be made available in other formats on request. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 8 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 Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was providing prospective residents and their representatives with information to make a choice about the home and generally residents are assessed before entering the home. EVIDENCE: The home has a statement of purpose and a specific service users guides for Sutton Lodge and Sutton Hall. There is information about Orchard Care Homes on display in the reception areas. During the site visit the statement of purpose was seen in a bedroom of a resident and a relative visited to look around the home. Also, although a relative from Sutton Lodge said they had not received written information Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 10 about the home before their relative had moved in, they explained they had attended an open day held by the home. On Sutton Lodge two residents records that had been recently admitted were looked at, both had a copy of the North Yorkshire County Councils care plan and an assessment of the residents needs. On Sutton Hall three residents, records that had recently been admitted were examined. One was an emergency admission and the assessment had been completed on the day of arrival, a second had both North Yorkshire County Councils care plan and an assessment of the residents needs, the third had no information from other services about the residents needs and the home had not completed a assessment. At the previous inspection a requirement had been made for the home to fully assess residents before admission, generally although this could be more detailed the home has now commenced gathering information about the resident prior to admission so it is able to identify whether or not it can meet the needs. From the thirteen surveys returned from relatives, eight said they were satisfied with the overall care the residents received. However, evidence found during the inspection in regards to the numbers and skills of staff would indicate that the home is not always able to meet the needs of all the residents. The home is able to admit residents who are from the age of fifty-five years of age with dementia. To be able to meet these residents needs fully the home would have to consider whether at the time of admission they are able to help that person maintain both their daily life and social skills. Many of the residents would have been unable to visit the home due to their health. The home does not offer intermediate care. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the staff have made some improvements to the care provided insufficient staff, poor communication about residents health needs and medication practices continue to put residents at risk. EVIDENCE: At the previous inspection a requirement was made for all residents to have a service user plan which gives clear guidance to staff about how to provide support for the care needs. Generally, the management have made definite improvements to the service users plans, however they now need to look at ways of ensuring all the care workers have this information so they can provide for the residents health care. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 12 On Sutton Lodge all residents had a service user plan, five were looked at in detail. All contained life histories of the residents, and general assessments of personal care, well being, diet and weight, medication, mental state and cognition. Where the assessment had identified a need for support, some had a care plan, which had the actions the staff, should take to meet these needs. All had been reviewed regularly but there was no evidence that the resident or their representative had been involved in this process. However they only had very general statements, and were not specific to the individual, some were inconsistent. Examples of this are, when a resident could display challenging behaviour, there was nothing about how this was to be managed and the actions to take to minimise this behaviour. Another was confusing as to how many times a blood sugar test was to be monitored. Following a recommendation at the previous inspection, the management have introduced an allocated worker (key worker), system to help staff understand the needs of the residents better. Generally, care assistants spoken to during the day and night said they were aware of the care plans but did not have time to read them and some said they were difficult to follow; the care plans for the residents on the first floor were kept on the ground floor. This was evident from the records where information was not being communicated about resident health needs, examples of this was a resident was to receive a special diet before retiring and an early breakfast and they were not always receiving it, other residents who had lost weight and needed to be weighed each week were not being weighed. Residents had access to a chiropodist, dentist optician and general practitioner and eight out of thirteen relatives said they were satisfied with the overall care provided by the home. During the inspection process, relatives and health professionals have had concerns about residents loosing weight. The home has supplied evidence which shows a number of residents have lost weight since admission. The management have responded to this by looking at the reasons this has happened for each resident and where a resident was not expected to loose weight, recording this information in their care plans and monitoring their diet. However, the site visit evidenced the management need to review this further as the system for recording what residents at risk were eating and information about special diets was haphazard and many staff were unaware of the residents nutritional needs. Staff explained all residents are offered a bath once a week and most residents during the site visit were washed when they rose in a morning by the night staff. Four relatives have said residents were not always shaved or clean and tidy however they were unsure whether this was the residents’ choice. One relative stated all a resident’s trousers had been lost and the resident was Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 13 wearing unfamiliar clothes. Further relatives commented on the loss of glasses and teeth in the home. As part of the inspection, an inspector sat in the lounge on the top floor and observed the interaction with staff for two hours. This showed that although staff were enthusiastic and warm to residents, they generally, only interacted with residents when there was a task to carry out such as helping them with food or a drink. Staff spoken to also said they did not have the time to talk with residents. Where relatives in Sutton Lodge had requested the resident room was to be locked to protect possessions, and staff were unable to communicate with the resident, this restricted the resident from using their bedroom during the day. For Sutton Hall two residents care files were looked at in detail. One where a resident was admitted in December only had a care plan written about a specific health problem they entered the home with on the day of the site visit. A further one who was admitted in December had no assessments or care plans. In Sutton Hall there was evidence residents do have access to health care services, one file evidenced the hospital being consulted about a resident. A resident also said all their health care needs were met and staff respond quickly to the call bell. In the home there have been concerns raised with the commission about the attitudes of the staff to residents in Sutton Lodge, which the management have immediately responded to. On the day of the site visit relatives spoken to made positive comments about the permanent staff, saying the residents were treated with respect. One said staff were ‘very dignified in their approach’; another said how ‘excellent’ they were. A sample of medication was looked at in Sutton Lodge where it was found the medication sheet in the care records did not always accurately reflect the medication listed on the medication chart. Residents were sometimes receiving their medication prescribed for 8 am at between 11.30am and 1 pm, for some residents this can cause adverse side effects. Also when there was one nurse on a night the medication round would take up to two hours. A relative also commented how staff did not make sure the resident always took their medication. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities are not meeting all the residents’ expectations. Residents are not always receiving a healthy varied diet according to their choice. EVIDENCE: Following the previous inspection, the home had increased the communal space for residents to use in Sutton Lodge by incorporating the reception areas. In Sutton Lodge all residents had a life history as part of their service users plan, and an assessment of their social interests and records of what activities the resident had carried out. However, these records showed few social activities being carried out. From November 2006 one resident had attended three sing-a-longs and one coffee morning, a second had two sing-a-longs and one playing ball with another resident. During both site visits, staff initiated singing for the residents. Both appeared to be started with little consideration for the choice of all the Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 15 residents in the room. For one, a member of staff turned down the TV before putting some music on. This meant that it was difficult for anyone watching the TV to be able to hear it. Apart from the singsong and the written programme from Orchard Care Homes, there was little evidence of any activities in the home. Comments from relatives and health professionals all stated there was little for the residents to do in both the Lodge and the Hall. However, the minutes of the relatives meetings showed relatives had offered to volunteer to come into the home to carry out activities. Observation for two hours in the lounge evidenced there was little conversation between staff and residents, and conversation was normally raised when the staff had a task to carry out or the resident was in need of help. Some of the residents were very active and walked around, many looked bored. Others remained in the lounge or reception area asleep for most of the day. The permanent staff who knew the residents better confirmed they generally did not have enough time to talk with residents or engage with them in any activities and felt their was a need for a activities organiser. In Sutton Hall a resident said they did not choose to join in social activities but relatives visit and staff pop in and say hello regularly, but another resident said there was ‘not much going on’. Relatives were observed visiting residents during the site visit some residents were also taken out by their relatives. In the pre assessment questionnaire the manager the stated the home was arranging for a church service to be carried out at the home. Staff said residents could choose when to rise and when to retire, many residents were observed getting up when they choose in the morning. Staff were observed offering residents some choices about their daily lives. Relatives can stipulate whether residents want their rooms locked or not to protect their personal possessions, but it was not clear whether residents who had difficulty in communicating would then have the choice to access their rooms easily during the day. During the site visit residents on the ground floor at Sutton Lodge were asked where they would like to sit at mealtimes. However, due to the number of residents who need help breakfast did not end until after 10 .30 am and lunch then commenced at 12.30 pm. Also the staff were concerned as they each had so many residents to help it often caused the food to become cold. Observation during the site visit and discussion with staff showed there is a poor system in place to make sure all residents who needed special diets Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 16 receive them. Or for making sure residents who may not eat due to their mental health needs consumed a nourishing diet. Subsequently, there have been concerns raised with the commission about the residents loosing weight. The management have responded to this by monitoring residents weights and reviewing how they make sure all residents consume a healthy diet, which will maintain their body weight. During one of the site visits the staff were making milky coffee for residents and making sure they received food supplements when they had not eaten their meals at lunchtime. The management are also planning to introduce buffet food for Sutton Lodge, which residents can eat whilst on the move. Discussion with the cook on duty evidenced they did not have an up to date food hygiene certificate. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ representatives are aware of how to complain, but lack of training and insufficient staff may put residents at risk. EVIDENCE: At the previous inspection, a requirement was made for the registered person to follow the complaints procedure. The home and the commission have received a number of concerns, complaints and allegations following the inspection of the 7th September. The registered provider has now made sure all members of staff in the home follow the complaints policy. Complaints, which had been made to the home, had generally been followed up by a member of staff and in some instances resolved. Residents and relatives generally all felt the manager was approachable and they were able to complain, and their complaints were listened to and resolved. The home has regular relatives meetings and relatives have explained how their general concerns where listened to and responded to by the provider. However, relatives have given examples of some complaints, which were made to the provider that remain unresolved. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 18 The previous inspection asked for all staff to attend protection of vulnerable adults training, and following the last inspection there have been allegations made, which are being addressed under the safeguarding of adults procedures of North Yorkshire County Council. Many of the staff spoken to have attended abuse training awareness provided in house, some had attended Bradford Social Services No Secrets Training and reported how informative it had been. However, discussion with staff and records showed that some staff still need training. The registered persons needs to make sure all the nursing staff have attended accredited training on safeguarding adults and all care staff have attended awareness training. They should also ensure all agency staff who are working in the home are appropriately trained. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the home offers a new, comfortable and well-maintained environment for resident. EVIDENCE: Sutton Hall accommodates ten residents on the ground floor, and ten residents on the 1st floor, all the bedrooms are en-suite. There is a small communal lounge/dining room on both floors; no other communal rooms are available. Inspection of this part of the home evidenced Sutton Hall was generally clean and well maintained. The hall is well equipped with profile beds and pressure relieving equipment. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 20 At the pervious inspection, a requirement was made to increase storage space, as the storage of hoists in corridors could be a risk to the health and safety of both residents and staff. This had not been carried out, however the staff did confirm plans had been made to meet this requirement. All the residents spoken with were comfortable in their bedrooms, and were encouraged to bring in personnel possessions and furniture, to promote a feeling of ownership. Call bells were within reach of residents and were responded to quickly. Sutton Lodge accommodates twenty residents who have dementia on the ground floor and twenty on the first floor; all the rooms are en suite. There is one communal lounge/dining room on each floor; the ground floor has a conservatory and access to an enclosed garden area. Both floors are locked with a keypad locking system. Inspection of this part of the home evidenced Sutton Lodge was clean and well maintained. However there was an offensive odour during the day and relatives have given examples of when they have visited and found residents rooms with offensive odour. Residents on the 1st floor will also have difficulty accessing the garden without staff support. A requirement was made to increase the communal space for residents; the reception areas on both the ground and first floor have been made for residents to use during the day. They also plan to turn the conservatory into a sensory area for residents to use. To help residents identify different rooms the home has started to use signage. The hallway lighting has been reviewed and increased. The bedroom lighting has still not been reviewed however the manager said this is planned for shortly. Activity boards and clock with the date and time are in the lounge areas. Staff were seen using disposable aprons and gloves appropriately. Some of the staff had undergone infection control training. Aids and adaptations are provided and regularly serviced. The home employs a maintenance man who is responsible for routine maintenance and the monitoring of some health and safety aspects of the premises. Records of water checks were reviewed and found to be adequate. Two full time staff carries out the cleaning and laundry for the home, however there have been negative comments made about the loss of residents clothes. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ health, welfare and social needs are not always met due to the insufficient numbers of staff. EVIDENCE: Generally, during the day Sutton Lodge has a registered mental nurse on the ground floor and one on the first floor, who are both supported by three care workers. On an evening there is a nurse on each floor supported by a care worker for part of the week, for the rest there is one nurse and three care workers between both floors. The home is attempting to recruit more permanent staff, however at the present time the home is using a large percentage of agency staff. The agency staff during the site visit was unaware of all the health care needs of the residents. At present, the ground floor has residents with greater physical needs; the upper floor residents have better mobility and less physical needs, but may have unpredictable behaviour. During an early morning visit to the home many of the residents had chosen to be in the communal areas. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 22 Care staff duties in the lodge include setting and preparing tables, washing up, also answering the telephone and taking messages when the manager is unable to answer the phone. Night carers also have cleaning duties in the lounge area that take up to one hour each evening. The nursing staff during the site visit were occupied with administration of medicines and completion of care records. This all makes the number and the skills of the staff insufficient to meet residents’ needs safely both during the day and on a night. Most of the staff and relatives also confirmed there are insufficient staff on duty to meet the needs of the residents. A requirement was made at the previous inspection about the staffing numbers on a day and on a night this requirement had not been met at this site visit. Generally, at Sutton Hall there are four staff on duty during the day, either two nurses and two carers or one nurse and three carers and one nurse and one care worker on a night. On a night when the nurse is carrying out the administration of medicines or fetching linen this leaves one care worker attending to residents needs located on two floors. An immediate requirement was issued to the provider on the 7th February 2007 for the home to increase the numbers of staff on night duty in both Sutton Lodge and Sutton Hall; this was to make sure there are sufficient staff to meet the needs of the residents on a night. The provider immediately responded and met this requirement. The pre assessment questionnaires shows five out of twenty permanent staff have completed their National Vocational Qualification in Care at level two or above. Three records checked all had criminal bureau record (CRB) and protection of vulnerable adult checks (POVA) and references. Staff also confirmed the home had followed the homes recruitment procedure. Following the previous inspection most of the staff have completed a basic induction training but few had completed any further formal training in the relevant areas such as health and safety, dementia care, how to manage challenging behaviour, mobility assistance and medication update for nursing staff. The home has recently enrolled many of the staff at Sutton Lodge on a long distance dementia care course. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider and manager have made improvements to the home, but further progress must be made to provide a good standard of dementia care. EVIDENCE: The manager of the home has only recently commenced in November 2006. She is a registered general nurse who has her certificate in management and hopes to commence a course in Dementia Care at Bradford University in February. She has commenced making an application to the commission to be the registered manager of the home. During the site visit, she talked enthusiastically about her commitment to improving the home. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 24 Staff spoken to all said they generally felt supported by the manager, morale was better and changes and improvements were happening. The manager is being supported by a newly appointed area manager who has experience of providing dementia care. The home has relative meetings, which are often attended by the registered provider where the relatives of residents can raise any concerns they may have about the home, minutes are taken and these are sent out to the relatives. The home is commencing a quality assessment tool, which will monitor the standards of care provided by the home and the area manager carries out regulation 26 visits. However the outcomes of this inspection process has shown these need to be further improved upon to make sure the home can identify where resident needs are not being met. The home does not hold money for residents. Speaking with staff evidenced the home has only recently commenced a programme of staff supervision. During the site visit talking with staff showed the fire training was not up to date, this was particularly concerning as four members of the night staff who were working during the site visit had not received fire training. The deputy manager who is the fire trainer agreed to stay and ensure all the night staff received fire training before they commenced work. Following carrying out the training, the commission were notified this training had taken place. The home did not have a copy of the fire risk assessment, they agreed to obtain a copy and send it to the Commission. One resident who had bed safety rails did not have a risk assessment in place despite an accident occurring with the cot sides. The manager agreed to immediately carry out the risk assessment. Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 25 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 3 X 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 X X X X 2 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 2 X 1 Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 Requirement All prospective residents should be fully assessed before they move into the home. The assessment should include in detail emotional, social, spiritual, occupational and physical needs of the resident. The assessment should involve the resident, and their representatives and relevant professionals. Previous requirement not met 21/09/07 Timescale for action 25/01/07 2 OP7 15 (2) All of the residents must have a 01/03/07 written care plan that includes all of the residents needs. • The plan must include clear guidance to staff about the support that they have to provide to meet residents needs. Consultation wherever possible should take place with the resident or their representative. The plan must be kept under review and residents or their representative Version 5.2 Page 27 • • Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc made aware of any revisions. Previous requirement not met 01/11/06 3. OP8 12 (1) , 13 (1) (b) 16 (2) (i) The registered person must review how residents in Sutton Lodge receive their food. The systems in place must: • Make sure all residents are receiving the correct diet. • Make sure all residents receive their food at the correct temperatures. • Involve the advice of dietician who has experience of working with residents with dementia • Make sure there are systems in place to recognise when a resident is loosing inappropriate amounts of weight and take appropriate action if this is recognised. 01/03/07 4. OP9 13 (2) The Registered Person must 25/01/07 ensure systems are in place: • To correctly and clearly record any changes of dosage and the reasons why these changes were made to the medications of residents. • To ensure all residents are receiving the correct dosage medication at the correct times. Previous requirement not met 21/09/07 01/04/07 The registered persons must provide following consultation with residents/representatives Appropriate activities for residents, which will enable them to maintain their life skills. Previous requirement not met 01/12/06 DS0000065908.V329213.R01.S.doc Version 5.2 Page 28 5. OP12 16(2) (m) and (n) Sutton Hall & Sutton Lodge 6. OP15 18 (1) (c ) The registered person must (i) make sure all staff that work in the kitchen have the appropriate food hygiene training. 13 (6) The Registered Person should ensure all staff are trained in the Protection of Vulnerable Adults and are aware of how to follow the North Yorkshire Procedure. Previous requirement 01/10/06 The Registered Person shall provide suitable storage for the purpose of the care home. Previous requirement not met 01/11/06 01/04/07 7 OP18 01/04/07 8 OP21 23(2) (l) 01/04/07 9. OP25 23 (p) The Registered Person shall 01/04/07 review and undertake the actions necessary to the lighting of the home to ensure it meets residents’ needs in their bedrooms. The home’s staffing level must 25/01/07 be reviewed to ensure that it is adequate to meet the needs of all of the residents at any time of the day and night. The staffing level must take into account the needs of the residents, the competence and experience of the staff and the layout and design of the premises. • On a night two members of qualified nursing staff and four care staff must be on duty on Sutton Lodge • On a night one member of qualified nursing staff and two care staff must be on duty at Sutton Hall Previous requirement not met 01/10/06. An immediate requirement was made on the 07/02/07 DS0000065908.V329213.R01.S.doc Version 5.2 Page 29 10. OP27 18 (1) (a) & (b) 18 (2) Sutton Hall & Sutton Lodge 11. OP30 18(1) (c) The Registered Person must 01/04/07 make sure: • All staff receives both a structured induction and the appropriate mandatory training to enable them to carry out their work safely. • Staff working in Sutton Lodge receive training in regards to dementia care and managing challenging behaviour • These must be by suitably accredited and experienced trainers. Previous requirement not met 01/11/07 The Registered Persons should ensure all staff are appropriately supervised. The registered person must make sure all staff both day and night have fire training, for night staff this must be a minimum and be made aware of the homes fire procedures of three monthly, for day staff this must be six monthly Previous requirement of 01/10/06 not met Also, send the Commission a copy of the fire risk assessment. The registered person must make sure all residents who are using bedrails have an assessment of risk carried out which must be regularly reviewed. 01/04/07 12 OP36 18 (2) 13. OP38 18 1 (c)23(4) (d) 01/04/07 14 OP38 13 (4 ) 25/01/07 Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations Information in the Service user guide and statement of purpose given to residents should accurately reflect the care and services provided by the home. The registered person should be able to demonstrate the homes capacity to meet the assessed needs of any residents from the age of 55 – 65. The Registered Person shall provide adequate communal accommodation to enable residents to see visitors in private, or carry out social, cultural and religious activities, without intruding on other residents in Sutton Hall. 2 OP4 3 OP20 Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 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 © 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 Sutton Hall & Sutton Lodge DS0000065908.V329213.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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