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

This inspection was carried out on 9th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 25/01/07

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 & Kate Shackleton Unannounced Inspection 09:30 9th July 2007 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.V343588.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.V343588.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 Limited Post Vacant. 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.V343588.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 25/01/07 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 near to the towns of 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 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 11th July 2007 was £530 to £630 per week. There are extra costs for hairdressing, newspapers, chiropody and toiletries. A copy of the inspection report is available at the home on request. Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called a pre inspection questionnaire. Information from surveys that were sent to people who live at the home, the relatives, health professionals and the staff. Six surveys were returned from people who live at Sutton Hall and five were received from their relatives and two health professionals. Four were returned by the relatives of people living at Sutton Lodge and one by a team of health care professional. Seven surveys were received from staff. An unannounced visit to the home. This was carried out by two inspectors and lasted over eight hours and included talking to staff and the temporary manager about their work and the training they have completed. And checking some of the records policies and procedures the home has to keep. Some time was spent talking with and observing people who live in the home. Four peoples records were looked at in detail. • • • What the service does well: People who live in the home and their relatives made many positive comments about the permanent staff team and the care they provide. For Sutton Lodge comments made were: ‘Staff show compassion and understanding of the patients condition.’ ‘Cannot speak too highly of Sutton lodge.’ ‘Wonderful caring staff.’ ‘Provide a friendly caring home were all are valued and treated with dignity and respect.’ ‘Permanent care staff are wonderful.’ For Sutton Hall the comment made were: • ‘They seem to care for the people they are looking after.’ Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 6 • ‘Permanent staff from new manager down appear dedicated and very caring towards the residents.’ The senior management have held relatives meetings. Where relatives have been able to raise any concerns they have about the care people receive and have been up dated about any improvements made to the home. What has improved since the last inspection? What they could do better: Where specialist health care needs are identified and a health professional has given instructions for the staff, the registered person needs to make sure these are followed. To make sure people receive a consistent approach in Sutton Lodge and to keep everyone safe when a person is displaying challenging behaviour a stepby-step guide of how staff should respond should be made. Robust systems need to be in place to make sure all medication is given to and stored safely for people in the home. Sufficient resources need to be made available to enable people to be offered a programme of activities, to enable them to maintain their life skills. The home has offensive odours in the communal areas which is unpleasant for people living in the home, the managers need to establish the cause of this problem and take the necessary actions to stop the odours. Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 7 Meaningful employment references need to be sought by the management, in order to make every effort to ensure that only suitable people are employed. To keep people safe bed rail assessments need to be kept with the care plans, so staff are able to follow them easily. 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.V343588.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.V343588.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): Standard 3 only. People who use this service experience good quality outcomes in this area. People will be assessed before admission to the home to make sure the home is the right place for them to live. We have made this judgement using a range of evidence, including a visit to this service. . EVIDENCE: At the previous inspection, the home was required to make sure everyone was fully assessed before they moved into the home. This is to make sure the home has the necessary equipment and staff to be able to care for people properly. Two peoples records were looked at who had recently been admitted to the Hall and the Lodge, both contained an assessment carried out by experienced staff before the person came to stay in the home permanently and information, Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 10 which had been gathered from other agencies, such as social services or health professionals. These documents and the homes assessment visit by staff would have enabled the staff to assess whether they were able to meet people’s preferred or specialist needs. One person living in the home was able to confirm they had been fully informed about Sutton Hall before moving in. And how the staff had helped to make sure the move into the home was as comfortable as possible, by initially calling into their room regularly to make sure they were alright. Staff were able to explain how many people were unable to visit the home due to ill health, so the visits were generally carried out by relatives. During the afternoon of the site visit, the staff were expecting to show relatives around the home. Also, to help people feel welcome flowers are put in their rooms and they receive a welcome pack, which informs them about the services the home provides and the general routines. Most of the people who returned surveys from Sutton Hall stated they had received enough information. A comment made was: ‘We liked the way we were given the freedom to look all around and speak to residents and staff.’ The home does not provide intermediate care. Sutton Hall & Sutton Lodge DS0000065908.V343588.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): Standard 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. People are treated with respect and dignity by the staff and they receive personal care based on their individual needs, however the managers need to continue to strengthen communication and medication practices to make sure people are safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People and their relatives who use the service made many positive comments about the permanent staff team and the care they provide. For Sutton Lodge comments made were: ‘Staff show compassion and understanding of the patients condition.’ ‘Cannot speak too highly of Sutton lodge.’ ‘Wonderful caring staff.’ Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 12 ‘Provide a friendly caring home where all are valued and treated with dignity and respect.’ ‘Permanent care staff are wonderful.’ For Sutton Hall the comments made were: • ‘They seem to care for the people they are looking after.’ • ‘Permanent staff from new manager down appear dedicated and very caring towards the residents.’ During the site visit in both units staff were observed providing personal care and responding to requests for help with warmth and in a kind, considerate way. Personal care was offered in a manner, which was respectful and promoted peoples dignity. Although there were some very positive comments made about the care provided by the permanent staff team, the home has had difficulty in recruiting care staff and has relied heavily on staff supplied by agencies. Other comments received were negative and indicated the type of care provided was dependent upon the staff on duty at the time such as: For Sutton Lodge Surveys received from health professionals when asked does the agency seek advice and act upon it to manage individuals health care needs responded, ‘Sometimes depends upon member of staff no consistent approach.’ For Sutton Hall Although four people living in Sutton hall stated staff always listen and act on what they you say, one stated ‘’Most of the time they do some better than others.’ Relatives also implied the level of care received depended upon the staff giving examples of minor matters occurring and relating them to the ongoing heavy reliance on agency staff where information about people had not been transferred. People living in the home during the site visit were observed to be clean and well cared for, although two surveys were returned which indicated people were occasionally wearing other people’s clothes and there were problems with the laundry service. At the previous inspection, a requirement was made for all the people in the home to have a written care plan and the provider had supplied an improvement plan to the Commission where they had stated this would be carried out. To assess this two peoples’ case records from Sutton Hall and two from Sutton Lodge were looked at in order to check that these plans were in place and would help staff provide support to people in the home according to their needs and wishes. Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 13 At Sutton Hall The two records looked at, had detailed assessments of all the different ways a person may require help with their health care, such as nutrition, mobility and dexterity, communication, social activities. Where a need for help was identified, a plan was made of how this help was provided and had been reviewed monthly. Daily records had been made which recorded any changes to the person’s health and would have enabled staff to identify any further health needs. However, although both people had bedrails and one confirmed these were being used no records of these could be found on the care plans. The manager and nurse explained the records had been removed for everyone living in the home, as they were reviewing for everyone whether bed rails were necessary. Sutton Lodge The two records looked at had detailed assessments of the persons needs, where specialist care was needed a care plan had been generated, which had been reviewed regularly. Both had been agreed with a representative of the person in the home. Specialist areas were covered in detail such as mental health and cognition, and communication. However in two areas where specific needs had been identified such as the need to monitor fluid intake due to their drugs, no fluid or nutritional monitoring was being carried out, and where a care plan asked for the person to wear safe footwear this was not occurring. The record in the lodge also identified people’s continence needs but the actions identified were mainly reactive, and there was a strong smell of urine in the communal areas. The manager explained this issue had been identified and ways of promoting continence were being acted upon. In both units staff confirmed they do use the care plans In Sutton Lodge and the Hall the records evidenced staff were promoting peoples health care needs and people were able to access district nurses, doctors, chiropodists, and optician. People who use the service also confirmed this. At a independent pharmacy inspection carried out on the 5th June 2007 the judgement made was there is a lack of a robust system within the care home for the recording, storing and administration of medicines and this puts people at risk of not receiving medication as prescribed. Requirements and recommendations were made to the home, which the manager is presently working towards achieving. Sutton Hall & Sutton Lodge DS0000065908.V343588.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 11, 12, 13 and 14. People who use this service experience adequate quality outcomes in this area. People in the home are now provided with some appropriate social activities; however further resources need to be made available to make sure everyone’s needs are fully met. Generally, people are offered nutritious food of their choice. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The previous report required that following consultation with people in the home or their relatives, appropriate activities, which would enable them to maintain their life skills were to be offered. The provider stated in their improvement plan given to the Commission, more resources and time would be made available for activities in the home and activities will be included in the care plan. From the sample of records reviewed activities had been included in the care plans. The staffing records and speaking with a member of staff, also Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 15 evidenced some care staff had received training in how to deliver appropriate activities in the home. During the site visit a group of people in Sutton Lodge were observed listening to hymns, a further group were playing a board game, and a game of dominos was being arranged and a person was given a lighting strobe to help calm them. An activities programme was displayed in reception. In Sutton Hall the nurse explained due to peoples ill health activities were offered on an individual basis, such as manicures. On the day of the site visit people were mainly in the lounge watching television or in their rooms. However, surveys returned by relatives and health professionals and staff commented on the lack of activities and outings, and the need for an activities organiser in the home. Three staff explained how the people were allowed to make choices about their routines, such as when to rise and retire, and one of the nurses in charge of the unit explained how she encouraged the staff to see this as the persons ‘home’ and how they were enabled to move around the home as they wished. On the ground floor people were observed using the enclosed garden. Also staff were observed enabling two people who had developed a friendship but were on different floors in the home to meet and spend time together. Staff were seen interacting with people in Sutton Lodge in a friendly and warm manner, positive interactions were occurring which people appeared to benefit from and enjoy. People appeared to like the permanent staff. At the previous inspection, some people were found to be loosing weight. So the management were required to make sure people were receiving their correct diets and peoples weights being monitored. In the improvement plan supplied to the Commission, the management responded they would provide dementia nutritional training to staff, and give people in the home freshly prepared meals of their choice. Also, they would refer to the dieticians if needed. During the site visit good practice was observed in the Lodge where people were shown the different meals so they could make a choice, meal times were relaxed and the staff were trying to make the meals an occasion. At teatime, the tables had been moved to enable everyone to sit together. Staff were seen helping people to eat offering the correct utensils and talking to people as they helped. Cold and warm drinks were offered to people throughout the day, and snacks. For instance one person was given a mars bar and others sat with bowls of crisps. The training records showed staff had received training on dementia and nutrition. Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 16 Care plans showed weights were being recorded regularly and the staff explained where necessary records were being kept of what people were eating. Also the homes quality assurance system now includes a check to make sure peoples weights are not all reducing. The recent weights recorded showed people’s weights were being followed closely for Sutton Lodge. Identification and assessment of why people who are loosing weight must continue to help them maintain their physical health However the surveys and comments made by a person in the home, still described people as not receiving their correct diet or the soft diet being unappetising. The management need to continue to look at ways of making sure everyone receives their correct diet and of improving the soft diet. At the previous inspection the home was required to make sure all staff that work in the kitchen have the appropriate food hygiene training, the chef working in the kitchen and the records confirmed this had been carried out. Sutton Hall & Sutton Lodge DS0000065908.V343588.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. People who use this service experience good quality outcomes in this area. People are safeguarded from harm and complaints are taken seriously. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service has a clear complaints procedure, which is displayed in the home and included in the Service User Guide given to people in the home or their representatives. Since the last inspection of the home the Commission for Social Care Inspection has received two complaints. One related to a persons medication, which was investigated by the homes management and resolved. The second complaint related to staff shortages at night and peoples safety, in response the Commission visited the home and required them to increase the numbers of staff of at night which they immediately did. The complaints log examined showed that management responded quickly to complaints made and looked to resolve them in the best interest of people. All complaints logged had been responded to within the agreed timescales. Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 18 All the surveys returned to the Commission by people in the home, their relatives and the staff show that they know how to complain. Although fifty percent of relative’s surveys said that their complaints were not always responded to. There are policies and procedures for safeguarding adults to guide staffs practice. At the previous inspection a requirement was made to make sure all staff had received training in this aspect of their work. Talking with staff it was clear that they know what to do if they suspect that people are being harmed. Also during discussions with the manager, it was evident that she has experience in safeguarding adults and understands her role in referring any suspicions or allegations of abuse to the local authority for investigation. A monthly audit of complaints is carried out as part of the quality assurance scheme. Complaints are analysed in order to understand “lessons learnt” from investigations. Twice a year a senior manager from head office attends a meeting in the home where people living in the home and relatives are invited to share their views on the service delivered. Sutton Hall & Sutton Lodge DS0000065908.V343588.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 and 26. People who use this service experience adequate quality outcomes in this area. People live in a safe environment but the offensive smell of urine must be detrimental to the enjoyment of people who use and visit the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A requirement was made at the last key inspection of the home to improve the storage arrangements for equipment and this has been achieved. A requirement was also made to improve lighting in bedrooms. It was difficult to assess the lighting levels in the bedrooms at this visit because it was a bright sunny day. However, the improvement plan provided by the management following the last key inspection confirms that ‘lighting has been increased in bedrooms.’ Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 20 A tour of the premises included all of the public areas, some bedrooms, bathrooms, toilets, laundry and the kitchen. There is an offensive smell of urine in communal areas. Five randomly selected bedrooms were visited and they smelt fresh and were clean. The manager is aware of the problem and is working on ways to improve the freshness of communal areas. She explained that the home had experienced some staffing difficulties the two days prior to this visit whereby domestic staff had not turned up for work. Systems are in place to prevent the spread of infection. It was noted whilst visiting two bedrooms that the call bells did not have their extension leads fitted. This was rectified immediately. Surveys relating to the cleanliness of the home provided a mixed response. People living in Sutton Hall stated on their surveys that the home is generally clean, and two of the staff surveys say it is good however another five stated it is generally only adequate or poor. Aids and adaptations are provided and regularly serviced. One relative commented that there is limited equipment saying that there is ‘only one slide sheet, one handling belt and one stand aid for sixty people.’ Checks made on this type of equipment found adequate supplies with a further six slide sheets and handling belts on order. The home employs a handyman that is responsible for routine maintenance and the monitoring of some health and safety aspects of the premises. Information provided by the manager and the sampling of some health and safety records showed that every effort is made to provide a safe environment. Staff receive fire training and fire equipment is routinely serviced. A fire risk assessment of the premises has been completed. A record of hot water temperatures is kept to ensure the delivery of safe hot water and prevent the risk of scalding. The servicing of the lift and gas installation is up to date. Sutton Hall & Sutton Lodge DS0000065908.V343588.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. People who use this service experience adequate quality outcomes in this area. People receive care from a trained staff team. Some aspects of the recruitment process has the potential to recruit unsuitable people placing people at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager explained staffing levels have increased since the home was last inspected. Staff during the site visit were observed responding quickly and appropriately to requests from people living in the home and spending time talking to them. Staff explained when the home is fully staffed there are enough staff to meet the needs of people in the home. Discussions with management found that recruitment in the area is difficult which means agency staff often has to be used to cover some shifts. A relatives survey commented upon the difficulties that arose when the home was reliant upon agency staff. Two relatives surveys say there are not enough staff and one commented ‘I can never find qualified staff when I visit.’ Also, people who live in Sutton Hall surveys provide a mixed response one saying there are always enough staff available, two say usually and one saying sometimes. Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 22 Health professionals also commented ‘there were not always enough staff available to be able to take clients out.’ Staff spoken to and training records examined showed that everyone gets an induction. The training programme seen covers all mandatory training e.g. fire training, moving and handling, food hygiene and health and safety. Specialist training includes dementia care, nutrition, medication and care planning. Day staff said that the training is good and helps them to meet the individual needs of the people using the service. A quarter of the staff have achieved their national vocational training at level 2 in care or above. However, feedback received from health professionals who have provided dementia care training to staff in the home described the attitude of some of the staff during the training as dismissive. Three staff files examined showed that a recruitment process takes place. Application forms are completed and an interview takes place. References are sought and include a Criminal Records Bureau check. Currently head office administrative staff process job applications. However, more attention needs to be paid to the content of some references received and the relationship between the referee and candidate. For one staff, one of the two references sought was provided by the candidates ‘best friend’ and the previous care home employers reference only confirmed dates of employment and gave no opinion as to the character of the candidate. The employment history of the candidate showed previous employment in another care home where a reference could have been asked for. There was a similar situation with another member of staff where the referee only confirmed dates of employment and did not complete the information asked for by the home relating to the persons suitability to be employed in a care setting. During the inspection it was discussed with the manager how the management of this process could be improved to make sure that meaningful references are sought in order to make every effort to ensure that only suitable people are employed. Sutton Hall & Sutton Lodge DS0000065908.V343588.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, 35 and 38. People who use this service experience good quality outcomes in this area. The home is managed in a manner that seeks to improve standards of care in order that people receive a better service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager recently resigned and the two-deputy managers posts are vacant. A new manager has been appointed. The new manager will take up post towards the end of July. In the interim Miss Debbie Campey the Senior Support Area Manager is managing the home. She is a Registered General Nurse and has twenty years experience of managing care homes. Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 24 There are clear lines of accountability within the organisation and the homes manager is supported by a senior area manager. There is a quality assurance scheme where monthly audits of key aspects of the business are monitored. The area manager visits at least monthly to check audits and agree an action plan where any shortfalls are identified. The manager said there is a business plan for the home kept at head office. As part of checking quality, twice-yearly surveys are sent to people living in the home and their next of kin and staff. Meetings are also held where people can express their views. In response to the surveys and meetings action are taken toward improving the home. Staff files confirmed that formal staff supervision takes place and staff spoken with said they feel well supported to do their job. Regular staff meetings are held. The home does not hold money for residents. The safety and well being of people living in the home and staff is promoted through appropriate policies and procedures, staff training and risk assessments. The home works to a clear health and safety policy and regular safety checks are carried out. Records of checks and staff training are well kept and up to date. Staff training programmes includes Health and Safety training. However the records looked at did not contain the necessary bedrail assessments, the management need to make sure all the bed rails assessments are carried out and are made available to staff. Sutton Hall & Sutton Lodge DS0000065908.V343588.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A 3 X 2 Sutton Hall & Sutton Lodge DS0000065908.V343588.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 OP8 Regulatio n 12 (1) (a) Requirement The registered person must make sure where a person health needs dictate that either the amount of fluids or food needs to be recorded and monitored, it is carried out. The administration of all medicines must be accurately recorded. This means that there is a record of medication being given as prescribed. Timescale for action 09/07/07 2 OP9 13 (2) 09/07/07 3 OP9 13 (2) Medication with limited number of 09/07/07 days of use should have dates of opening. This makes sure that the medicine is safe to use. The management should continue to review its staffing numbers and increase them when necessary to make sure the needs of people in the home are always met. To make sure only suitable people are employed the management must make sure it receives references which advise DS0000065908.V343588.R01.S.doc 4 OP27 18 09/07/07 5 OP29 19 01/08/07 Sutton Hall & Sutton Lodge Version 5.2 Page 27 on the suitability of the applicant, these references should not be from friends. 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 OP7 Good Practice Recommendations To make sure people receive a consistent approach and to keep everyone safe when a person is displaying challenging behaviour a step-by-step guide of how staff should respond should be made. All medication ointments kept in peoples rooms should be kept in locked cupboards to prevent them from being tampered with. The medicines policy needs to be updated. This makes sure there are procedures in place for staff to follow which reflect up to date legal requirements and guidance. Medication in use and in date should be carried over to the next month and the quantity recorded on the new MAR. This helps to check that medicines are being administered correctly. A record of supply and disposal of controlled drugs must be made. This means there is a complete record of these drugs. Controlled drugs no longer in use should be disposed of promptly. An accurate record must be made of handwritten MAR entries and of any changes to medication. This makes sure people are getting their medication as prescribed. A system should be in place to make sure that the temperature of the medicines storeroom does not exceed that recommended by the manufacturer. This helps to make sure that medicines are safe to use. 2 OP9 4. OP9 5. OP9 6. OP9 7. OP9 8. OP9 Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 28 9 OP12 Enough resources should be made available to make sure everyone in the home has access to meaningful daily activities. To make sure the home is a pleasant environment for people to live it, the reasons for the smell of urine should be established and the smell removed. The registered person must make sure everyone who is using bedrails have an assessment of risk carried out which must be regularly reviewed, this should be kept with the care plan. 10 OP26 11 OP38 Sutton Hall & Sutton Lodge DS0000065908.V343588.R01.S.doc Version 5.2 Page 29 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.V343588.R01.S.doc Version 5.2 Page 30 - 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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