Inspection on 07/09/06 for Sutton Hall & Sutton Lodge

This inspection was carried out on 7th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sutton Hall & Sutton Lodge 08/07/08

Sutton Hall & Sutton Lodge 09/07/07

Sutton Hall & Sutton Lodge 25/01/07

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 7th September 2006 09:00 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 Hall & Sutton Lodge DS0000065908.V311551.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.V311551.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 Ms Alison Dodds 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.V311551.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. This is the homes first inspection following registration Date of last inspection 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 accessible by local transport from Keighley and Skipton. Sutton Lodge is registered to provide care up to forty people some from the age of fifty-five who have dementia and require nursing. The home is on two floors with twenty en suite bedrooms on each floor and a passenger lift. The lower floor of Sutton Lodge has access to an enclosed garden. Sutton Hall is registered to provide care for twenty older people who require nursing. The home is two on two floors with ten en suite bedrooms on each floor. The lower floor of Sutton Hall has access to the gardens. The cost of a weeks care on 14th August was £410 - £550 per week. Sutton Hall & Sutton Lodge DS0000065908.V311551.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 on the homes file held at the Commission for Social Care Inspection. An unannounced site visit, lasting over 11 hours, by two Regulation Inspectors, which included a tour of the premises, talking to residents, relatives, staff and the Registered Manager. Observing staff working with residents and the examination of records. Five residents care was looked at in detail. Letter surveys were sent to 11 residents and 13 relatives, and 4 health professionals, 5 residents, 9 relatives, 3 health professionals and 1 care manager responded. What the service does well: What has improved since the last inspection? This is the homes first inspection following registration. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 6 What they could do better: The information provided to prospective residents, their families and other representatives must be up to date and accurate in order to be sure that they can make an informed decision about moving into the home. The home must have a better and clearer understanding of the individual needs of their residents with dementia to enable them meet the social, health, and welfare needs of these residents. Residents must have a care plan that has been agreed with them or their representative. It should be written in plain English, easy to understand and consider all areas of the individual’s life including health, personal, cultural and social care needs. The plan must include the support that staff have to provide to meet the needs of residents whilst maintaining their ability to retain some independence. Areas should be identified where staff are willing to support residents to take some risks in order for them to live interesting and fulfilling lives. A key worker system would help this process allowing staff to build up special relationships with residents and work on a one to one basis with them. Plans must be properly reviewed and where needs have changed, action taken and the plan amended accordingly. Good care planning means that residents receive a service that is specifically designed to meet their diverse care needs. All residents must have access to a dentist and a chiropodist if needed, so that their healthcare needs can be met. Information about residents’ medicines collected before and following admission needs to be recorded correctly in the residents’ files, correct recording of medication and any changes that may occur ensures residents are receiving the correct dose and are aware of why any changes have been made to their medications. Locking residents bedrooms routinely in the Lodge without their permission, does not promote the resident right to respect and privacy. Residents need to be able to access their own rooms when receiving medical or personal support, or when they wish to use their own toilet facilities unless there is a recognised risk to the resident. The procedure of the head office in Leeds planning activities programmes, which are carried out by the care staff, on a weekly cycle does not promote good practice in Sutton Lodge. Activities for people who have dementia need to maintain their life skills, and suit their individual needs and capabilities. To enable this to happen activities often need to be on an individual basis, where interests and life histories are sought, recorded and acted upon. The key worker system would enable closer resident staff relationships where likes dislikes and needs are shared, Key workers can then plan the activities that residents enjoy. All residents should be given a choice about the food they prefer, lunch times should be treated as an occasion something the residents can look forward to a Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 7 time when staff listen to and talk with the residents. Time spent communicating over meal times can contribute towards the maintaining the residents life skills. The complaints procedure needs to be robustly followed by management. Complaints need to be properly recorded in a manner that informs residents and their representative that issues are followed up speedily and the information is used to improve the quality of the service provided to residents. To protect residents the management need to ensure staff are trained to recognise abuse and are able to follow the procedure. Sufficient staff resources must be made available to ensure the home is able to protect the residents and meet their health, personal and welfare needs fully. To enable staff to communicate well with residents who are who have dementia extra time is often needed for them to respond. The pressure on the staff to work quickly and complete tasks means they are not able to give residents time to communicate their needs fully, more time would improve the quality of the care provided to residents. Staff need to be provided with appropriate training to ensure the resident receives both the up to date, appropriate and best quality of care available. Further communal space should be available for residents to either meet with their relatives in private or for recreational activity. On the first floor of Sutton Lodge, there is only one space available, for twenty residents. This means any recreational activities that take place disturb the other resident using the room. There is insufficient storage space, bathrooms and bedrooms are being used to house equipment, this prevents residents from using the facilities and may cause a health and safety risk. The home needs to have clear and effective leadership and management during the first six months, without this the quality of the service provided for residents may not improve. 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 Hall & Sutton Lodge DS0000065908.V311551.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.V311551.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Quality in this outcome area is adequate. Residents’ do not know if the home will meet their needs, due to the assessment not including all the necessary information to provide care, especially for people who have dementia. This judgement has been made using available evidence including a visit to the home, discussion with and surveys from residents, relatives, staff and management. EVIDENCE: Pre admission assessments were carried out by the Registered Manager and by other suitably qualified staff before admission to the home, this assessment covered all aspects of the residents’ health and personal needs. However examination of four resident files evidenced the assessment forms completed and information received from other were agencies did not always give a detailed reflection of all of the needs of the prospective residents, especially for people who have dementia. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 10 Discussion with staff and looking at the care records evidenced it was difficult to establish whether the information provided on admission was being passed on fully to staff to enable them to care for all the needs of the residents. Two residents and two relatives spoken to said they had received verbal information about the home, five residents surveys returned all said they had received enough information about the home, and during the site visit relatives were being shown around the home. One relative wrote the resident had received a wonderful welcome pack of flowers, chocolates, soaps and even a dressing gown on admission. However no one could recall whether they had received any written information about the home before being admitted. The Statement of Purpose and the Service User Guide do not truly reflect the service the home can offer to the residents at the present time. The Registered Manager explained this is presently being reviewed by the organisation. The home does not provide intermediate care. Sutton Hall & Sutton Lodge DS0000065908.V311551.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome group is poor. Residents’ individual health and personal care needs are not always met by the home. This judgement has been made using available evidence including a visit to the home, examination of records and information given by residents, relatives, staff and health care professionals. EVIDENCE: Service user plans failed to address the diverse needs of the residents. The care records confirmed that although generally following admission to the home tick box assessments were carried for all aspects of care, the use of tick boxes did not encourage staff to identify the individual needs and actions necessary to provide care for residents. From the five resident records looked at, two records contained assessments only and no care plans; one resident plan identified the resident needed assistance with personal care but did not record the actions to be taken to provide the care. Another ticked the resident was diabetic and had nutritional Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 12 needs but did not record the actions necessary regarding their diet. A further one showed the resident was incontinent but there were no actions recorded that may help the resident remain continent. Due to the poor assessment of people who have dementia before admission to the home, the service user plans and risk assessments in the files examined did not fully address the behaviour of the residents and the actions, which needed to be taken to reduce the anxiety and distress of individual residents. Service user plans and life histories for people who have dementia should be person centred, detailed and need to contain the actions to be taken to maintain residents’ life skills and social confidence, as these residents are often unable to easily communicate their needs coherently themselves. Information from the assessment carried out prior to admission to the home was also not always incorporated in the care plan. An example of where information had not been passed on about a residents dentures was given by a relative, further investigation of the records evidenced where a initial assessment evidenced hallucinations there was no records of these in service user plan. There was no evidence the residents or their representatives were involved in the planning of their care needs or had been fully informed about any visits by other agencies. The Registered Manager explained the home has commenced introduction of a key worker system and staff should receive handover from the qualified nursing staff on their shift. Inspection of files and discussion with staff and relatives confirmed that information is not always given to staff accurately or in a formal way. During the site visit a member of staff had not been notified about a major incident that had occurred the previous night. From the five residents surveys responded to from Sutton Hall two stated they always and three stated they usually receive the care and support they need and all five said staff listen and act on what they say. A relatives commented ‘I think the care is good for a new unit it is very impressive thank the staff.’ The Registered Manager explained a local general practitioner visits the home two weekly to attend to all the residents needs, but many of the residents do not all have access to a chiropodist or dentist. This was confirmed by resident care files looked at, where there was no evidence in five files of visits from a chiropodist or dentist. In one file a resident admitted in May who had diabetes, had only been referred to the chiropodist the week before the site visit, information from relatives also confirmed the lack of a chiropody service for some residents. There was evidence in the files an optician had visited the home. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 13 From the five residents surveys responded to from Sutton Hall four said they always and one said they usually receive the medical support they require. During the site visit residents appeared appropriately dressed and generally clean, and staff were observed providing support in a kind and helpful manner. However health professionals and two relatives who visited the home on separate occasions said residents in the Lodge had been observed with food on their clothes and inappropriately dressed. Residents’ privacy and dignity is not always upheld in the Lodge. Two residents spoken to said the staff respects their dignity and a relatives survey commented on how they were very impressed with how residents are looked after by all the staff at the home. However a health professional explained how they had witnessed a. resident receiving care support in a toilet with the door open and a relative witnessed a resident being shaved in the lounge area of the Lodge. Health professionals also said when visiting residents in the Lodge they were not offered a private room to see their clients and generally had to see them in the Lounge area. In the Lodge residents rooms are routinely locked to prevent other residents from having access to them, only one resident has a key to their room. The keys to the Lodge were marked EMI with the room number, this labelling could be upsetting for the resident. Locking of residents’ rooms prevents access to their toilet facilities and only gives the residents use of the corridors and lounge area during the day. There was no evidence in the service user plans these actions had been risk assessed or agreed with the residents or their representatives. During the site visit inspection of the medication systems evidenced the home, stored and dispensed medication appropriately, but their was evidence from a residents file that information from the assessment prior to admission is not always recorded correctly and may not be passes on. The example found during case tracking was the medication records identified discrepancies between the treatments prescribe, information in the hospital discharge summary, assessment by the home and daily records. Not recording or ensuring the correct information is incorporated in the service user plan could lead to the resident receiving the wrong medication. An immediate requirement was left for the Registered Person to make arrangements for the medical review of the resident identified at the time of the site visit. Sutton Hall & Sutton Lodge DS0000065908.V311551.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, & 15 Quality in this outcome group is poor. Residents do not exercise choice and control over their daily lives and social interests. This judgement has been made using available evidence including a visit to the home, examination of records and information given by residents, relatives, staff and health care professionals. EVIDENCE: Service user plans looked at in detail in the Lodge, did not contain a detailed life history of the resident, which would enable them to plan for the social needs of the residents. Where social interests assessments had been completed there were brief and no plans had been established. Without this information it is unlikely that these particular needs of residents are met. There was also no evidence of any consultation with residents or their representatives that would enable residents to enjoy a full and stimulating life style with a variety of options to choose from. The head office in Leeds plans an activities programme, which is carried out by the care staff, on a weekly cycle. Some of these activities were found to be inappropriate for the residents in the home. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 15 During the site visit no activities were observed in the Hall. The residents surveys responded to from the hall where they are asked are - are activities arranged by the home that you can take part in? Two said sometimes, one said never, two did not answer the question. One written comment from a resident was ‘I would like to know what is available.’ In the Lodge in the afternoon residents were offered group activities that were generally inappropriate. These were; on the ground floor colouring in a children’s dot to dot colouring book, followed by a sing song and a walk outside and on the 1st floor, children’s jigsaws spelling simple words, and a manicure where nails were clipped in the dining area. In the Lodge residents were not observed enjoying a meaningful lifestyle, a resident whose care was looked at in detail remained in the same chair asleep for most of the day, including lunch. Other residents were also observed either asleep in chairs or wandering around the corridors; and could only access their bedrooms was by asking staff. Information received from health professionals and relatives also confirmed this is normal routine. Within the home there is limited communal space, generally all the activities take place in the lounge/dining area, this impedes on residents who do not want to be involved in the group activities and limits the type of activities which can be carried out with individuals. Activities for people who have dementia need to maintain their life skills, and suit their individual needs and capacities. To enable this to happen activities often need to be on an individual basis, where interests and life histories are sought, recorded and acted upon. Relatives were observed visiting residents during the site visit, one relative sat and ate with their relative in the lounge/dining area. One relative spoken to said they were always able to visit and were always welcomed by staff. However there were no quiet lounges where residents could see their visitors in private. The Registered Manager explained residents are taken to the local church on a Sunday. Residents’ surveys responded to from the Hall two stated the meals were always good and three stated they usually were. One commented the meals are very good and nicely presented. However a residents relative also wrote patients are given choices from the menu but these are not always adhered to and on occasions, all patients eat the same meal regardless of their personal preferences. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 16 The menu offered the resident five choices of meal but during the site visit only cheese and onion pie and peach crumble was being cooked, the Chef said jacket potatoes were available for those who asked. In the Lodge when staff were asked how do people who have difficulty communicating have their personal tastes met staff said they were generally given the first choice on the menu. As residents were generally restricted from their rooms, drinks were only available if requested from a member of staff. Sutton Hall & Sutton Lodge DS0000065908.V311551.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. Residents’ complaints may not be resolved due to staff not following the complaints procedure correctly; poor staff training may put residents at risk of abuse. This judgement has been made using available evidence including a visit to the home, examination of records and information given by relatives and health care professionals. EVIDENCE: The home had a complaints procedure, but there was no evidence this was been followed correctly. Although concerns had been raised there was no record of complaints or concerns that show the action that management take to arrange a speedy resolution in the best interest of the parties concerned. It is especially necessary for this information to be captured in the Lodge where due to the dementia care needs it is unlikely that they are able to make their own complaints and will have to rely on others to perform this task for them. Staff spoken to was unaware of the procedure for reporting suspected abuse. Some of the staff had received training on abuse as part of their induction, but other staff had not received any training. During the site visit contractors were observed walking freely into Sutton Hall without the knowledge of the staff, this could put residents at risk. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 18 The management operates a system that protects residents from financial abuse in circumstances where residents money is held for safekeeping. Sutton Hall & Sutton Lodge DS0000065908.V311551.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,25 & 26 Quality in this outcome area is adequate Although the home offers a new clean and well-maintained environment for residents this is severely compromised by the lack of provision of space for storage and recreational activities. This judgement has been made using available evidence including a visit to the home, examination of records and information given by residents, relatives and staff. EVIDENCE: The home is newly built and split into two parts Sutton Lodge and Sutton Hall. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 20 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 evidence generally Sutton Hall was clean and well maintained, and although some of the bedrooms wallpaper had been marked, which the Registered Manager explained was due to the profile beds, she had already made arrangements for these to be painted. Although the hall is well equipped with profile beds and pressure relieving equipment and one relative explained how the home had provided their relative with a specially adapted bed to meet her needs. There is a lack of storage space, a linen trolley was stored in an assisted bathroom, hoists were stored in an unoccupied bedroom. There were some concerns with some health and safety matters at Sutton Hall, on the ground floor of Sutton Hall a wheel chair and some cardboard were being stored under the stairwell. A immediate requirement was made at the site visit for the Registered Person to make arrangements for the wheelchair and the cardboard to be removed from the stairwell at Sutton Hall and also for the Registered Person to ensure that at no times pathways to fire escapes be obstructed. 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 in place. Inspection of this part of the home evidenced Sutton Lodge was clean and well maintained. All residents who responded to the survey and those spoken to said the home was clean. Within Sutton Lodge there is insufficient separate recreational space to allow residents to see visitors in private or carry out social, cultural and religious activities, without intruding on other residents. Also during the site visit Staff were observed using the conservatory as a meeting room, this is not acceptable as it intrudes on the already limited communal space of the residents. Residents on the 1st floor will also have difficulty accessing the garden without staff support. All the rooms in Sutton Lodge have a Perspex holder of the doors so residents can put something in it to enable them to easily recognise their own room. One room had a photograph in it to enable the resident, which enabled the resident to recognise their room. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 21 The downstairs bathroom door of Sutton Lodge was found to be difficult to open, and could be a hazard to residents, the Deputy Manager was made aware of this and was making arrangements to repair. An assisted bathroom room was used for storage containing a vacuum, zimmer frame and slippers; this restricts use of this facility for the residents and could be a risk to their health and safety. Throughout the building the lighting appeared dim, two residents both expressed difficulty when reading in their rooms, both had bought extra lamps to enable them to read. For people who have dementia there is an importance to maximise natural light, although low lighting is calming, some people may experience hallucination or delusions. Dim shadows and glare can create an environment, which distorts images further. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 22 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): 27,28,29 & 30 Quality in this outcome group is poor. Despite the staffs good will and enthusiasm, inadequate numbers of staff and poor training mean residents needs are not always met. This judgement has been made using available evidence including a visit to the home, examination of records and information given by residents, relative, and staff. EVIDENCE: Residents’ needs are not met due to insufficient and poor allocation of staffing resources for the assessed needs of the residents and the layout of the home. This was evidenced through the rota, particularly on a night when there is one qualified member of staff to dispense medication to all forty residents in the Lodge and where there is only one carer and one qualified member of staff working in the Hall during the night. During the day care staff are expected to serve meals and wash up, provide activities for residents and all personal care. Staff spoken to also said they did not have the time to speak to residents and always meet their needs. There are no administration staff in the home, administration is carried out by the Registered and Deputy Manager. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 23 Residents said the staff were kind and helpful, a relative spoken to said the staff were always responsive, during the site visit staff in the Hall were observed responding to the call bell quickly. Although the home has stated only 22 of staff have NVQ Level two or above in care, during the site visit a NVQ trainer was in the home working with care staff. In order to ensure a workforce whose practice is up to date and in line with current best practice this percentage needs to improve to 50 . Four staff files were inspected all confirmed the home operates a robust recruitment procedure, which ensures the protection of the residents. Although the staff were enthusiastic about training, and some of the new staff had undergone induction when the home was first opened, some mandatory training still had to be carried out this included health and safety, first aid, fire, abuse and mobility assistance. In the Lodge care staff had not been fully trained in how to meet the needs of residents who have dementia or about how to manage Challenging behaviour. This was evidenced through discussion with staff and inspection of records. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 24 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, 33 35 37 38 Quality in this outcome area is poor. Unsatisfactory management has led to not good enough outcomes for residents. This judgement has been made using available evidence including a visit to the home, examination of records and information given by residents, relatives and staff. EVIDENCE: The shortfall in the outcome of personal healthcare support, daily life and social activities, complaints and protection and staffing evidences the residents do not benefit from a well run home. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 25 The home is newly built and was only opened in April, Mrs Dodds was Registered with the Commission in July as Registered Manager, she is at present working towards her management qualification. Although Mrs Dodds has limited experience of Dementia Care, she is supported in her role by Registered Mental Nurses in the home. On registration of the home, the Registered Person explained a senior manager on a regular weekly basis would give Mrs Dodds support for the first three month of the homes opening. From discussion with the Mrs Dodds this level of support does not appear to have occurred. Information from relatives, staff and the site visit has evidenced a lack of organisation and management of the home. Care staff at the home said they found the management unapproachable and they felt there was a lack leadership. Although residents’ money is safeguarded, for recording money case receipt book is used but this does not have separate pages for each residents. It was recommended that a separate page be used for each resident to make the records clear and to meet data protection guidelines. The home operates a quality assurance programme, residents and relatives receive questionnaire designed by the head office and Regulation 26 visits are carried out by the Area Manager. The home had held a relatives meeting on the evening before the visit. Inspection of records during the site visit evidenced they were not generally well maintained or cascaded to staff, it is essential to keep records maintained and everyone informed to ensure the smooth running of the home. All documentation in regards to health and safety was inspected at the time of registration of the home. Discussion with staff and records evidence some staff had not received training in health and safety, moving and handling and fire. This is particularly concerning in regards to fire safety, where staff spoken to said they had never been shown the fire exits. On the ground floor of Sutton Hall a wheel chair and some cardboard were being stored under the stairwell. An immediate requirement was made that the Registered Person must make arrangements for the wheelchair and the cardboard to be removed from the stairwell at Sutton Hall and must take measures to ensure at no times should pathways to fire escapes be obstructed. In a bedroom in Sutton Hall bedrails were found to be loose and not securely fitted and this puts the resident at risk. An immediate requirement was made for the Registered Person to make arrangements to secure the bedrails in the bedroom identified at the site visit and for risk assessments to carried out on all residents who currently use bedrails to ensure they are secure and safe. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 26 The accidents recording and reporting was poor, where residents had been taken to hospital the commission had not been informed, and copies of the accidents were not always placed on residents files, so that patterns of events could not be identified. Inspection of the records evidenced the home is not checking or recording water temperatures regularly. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 27 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 1 X X X X 1 3 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 2 X 1 1 Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14 • Requirement All prospective residents must be fully assessed. • 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. • The registered person must confirm in writing to the resident that after considering the assessment the care home is capable of delivering a service that meets their needs. A written care plan that includes all of the residents needs must be provided. • 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 DS0000065908.V311551.R01.S.doc Timescale for action 20/09/06 2 OP7 15 01/11/06 Sutton Hall & Sutton Lodge Version 5.2 Page 29 3 OP8 12 (1) , 13 (1) (b) 13 (2) 4 OP9 5 OP10 12 (1) (a) (2), (4) (a) 6 OP12 16(2) (m) and (n) 7 OP15 12(2) (3) 8 OP16 22 representative. The plan must be kept under review and residents or their representative made aware of any revisions. The registered manager must when necessary access treatment and advice from other health care professionals The Registered Person must make arrangements for the medical review of the resident identified at the time of the site visit (Immediate Requirement made 07/09/06) The Registered Person must 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. Also ensure all residents are receiving the correct dosage of medication. The locking of residents’ rooms should only occur when a risk assessment has been carried out and it is the best interests of the resident and has been agreed by the resident or their representative. These reasons and the agreement must be recorded in the service user plan. The registered persons must provide following consultation with residents/representatives a programme of appropriate activities for residents, which will enable them to maintain their life skills. The Registered Person should ensure residents accommodated in the lodge have a choice about the food they eat. The registered manager must • DS0000065908.V311551.R01.S.doc 01/10/06 21/09/06 01/10/06 01/12/06 01/10/06 01/10/06 Page 30 Sutton Hall & Sutton Lodge Version 5.2 9 OP18 13 (6) 10 OP18 13(6) 11 OP20 23 (2) (e) (g), (h) 12 13 OP21 OP25 23(2) (l) 23 (p) 14 OP27 18 (a) follow the homes complaint procedure. Following a complaint an investigation must take place and the complainant informed of the outcome any action to be taken. 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. For the protection of residents the Registered Person shall ensure no one can enter Sutton Hall without staff knowledge. 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 The Registered Person shall provide suitable storage for the purpose of the care home. The Registered Person shall review and undertake the actions necessary to the lighting of the home to ensure it meets residents needs • 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. • On night two members of qualified nursing staff and four care staff should be on duty on Sutton Lodge DS0000065908.V311551.R01.S.doc 01/10/06 01/10/06 01/11/06 01/11/06 01/11/06 01/10/06 Sutton Hall & Sutton Lodge Version 5.2 Page 31 15 OP30 18(1) (a) (c) 16 OP31 9 (2) (b) (i) 17 13 (4) 17 18 OP37 OP38 19 OP38 13 (4) (a) & (4) (c) 20 OP38 13 (4) On a night one member of qualified nursing staff and two care staff should be on duty at Sutton Hall The Registered Person shall provide the commission with a programme of training which ensures:• all staff have received the mandatory training • Staff working in Sutton Lodge have received training in regards to dementia care and managing challenging behaviour by suitably accredited trainers by January 1st 2007. The Registered Manager should undertake a accredited training in dementia care for older people. All records should be maintained in accordance with the Care Home Regulations 2001 The Registered Person must make arrangements to secure the bedrails in the bedroom in Sutton Hall and for risk assessments to carried out on all residents who currently use bedrails to ensure they are secure and safe Immediate requirement made on 07/09/06 The Registered Person must make arrangements for the wheelchair and the cardboard to be removed from the stairwell at Sutton Hall and must take measures to ensure that at no time equipment and at no times should pathways to fire escapes be obstructed. Immediate requirement made on 07/09/06 The Registered Person should monitor and record the water DS0000065908.V311551.R01.S.doc • 01/11/06 01/11/06 01/11/06 07/09/06 07/09/06 01/10/06 Page 32 Sutton Hall & Sutton Lodge Version 5.2 21 OP38 18 1 (c) 23(4) (d) temperatures to ensure it does not exceed 43 degrees centigrade. The registered person must ensure all staff to have fire training, and be made aware of the homes fire procedures. 01/10/06 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 2 3 4 5 Refer to Standard OP1 OP7 OP32 OP38 OP38 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 Consideration should be given to the immediate commencement of key worker system. The Registered Persons should ensure all staff receives a formal handover of information about residents needs. Sluice doors should always be locked. Details of accidents should be put on resident residents records to allow for patterns of events to be identified. Sutton Hall & Sutton Lodge DS0000065908.V311551.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 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.V311551.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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