Inspection on 15/01/08 for Sutton House Nursing & Residential Home

This inspection was carried out on 15th January 2008.

CSCI found this care home to be providing an Good service.

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 House Nursing &... 26/11/08

Sutton House Nursing &... 22/06/06

Sutton House Nursing &... 09/11/05

Sutton House Nursing &... 26/04/05

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

CARE HOMES FOR OLDER PEOPLE Sutton House Nursing & Residential Home Kingfisher Rise Ings Road Sutton, Hull East Yorkshire HU7 4FL Lead Inspector Beverly Hill Key Unannounced Inspection 15th January 2008 09:15 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 House Nursing & Residential Home DS0000062875.V358330.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 House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sutton House Nursing & Residential Home Address Kingfisher Rise Ings Road Sutton, Hull East Yorkshire HU7 4FL 01482 784703 01482 377881 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) Mr Barry Potton Position Vacant Care Home 38 Category(ies) of Dementia (38), Dementia - over 65 years of age registration, with number (38), Old age, not falling within any other of places category (38), Physical disability (38), Physical disability over 65 years of age (38) Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2006 Brief Description of the Service: Sutton House is a large elegant looking period building set in extensive grounds. It is located in the village of Sutton and is tucked away discreetly from the main road. The home is a registered care home that is also able to provide nursing care to people. Accommodation is provided over three floors serviced by a passenger lift and stairs. The ground floor has communal areas consisting of a large lounge divided into three distinct areas, a small sitting room, a large dining room and a quiet sitting area in the foyer. The home has a large garden with mature trees and shrubs, a patio area with furniture and ample space for parking. The home has eight shared bedrooms and three single bedrooms on the first floor and seven shared and five single on the second floor. All bedrooms have a separate room with en-suite facilities consisting of a toilet and washbasin. The home has two bathrooms and a shower room on the first floor and two bathrooms on the second floor. The manager confirmed that there were plans to convert one of the bathrooms on the second floor into a walk-in shower room to provide people with more choice. Equipment and aids/adaptations are in place to ensure people are cared for in a safe manner whilst allowing them to be as independent as possible. Information about the home and the services it provides can be found in the statement of purpose and service user guide. Both these documents as well as the latest inspection report are on display in the foyer and copies are available from the manager. The fee level advised at the time of the visit was £338 per week with a top-up of £20 per week for a shared bedroom and £40 per week for a single bedroom. Nursing clients also pay their nursing band determination on top of the basic fee. There are additional charges for hairdressing, private chiropody treatment, toiletries, outings and newspapers/magazines. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 22nd June 2006 including information gathered during a site visit to the home, which took place over one day. Throughout the day we spoke to people to gain a picture of what life was like for them to live at Sutton House and analysed the surveys returned from them. We also had discussions with the manager, care staff, catering staff and domestic staff. Information was also obtained from surveys received from staff members and relatives. Comments from the discussions and surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the service users, staff and management for their hospitality during the visit and also thank the people who completed surveys. What the service does well: The home provides a very pleasant environment for people to live and work in. It had a friendly and homely feel and there were different areas for people to sit. The home was clean with no unpleasant odours. One relative stated, ‘the house is well kept’ and a service user said, ‘the home is very nice, clean and tidy’. Visitors were welcomed at the home at any time and service users could have trial visits before deciding on a permanent place at the home. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 6 The manager made sure that all the care the service users required was written down in care plans with clear instructions to staff so they had full information about to meet peoples needs. The staff were friendly and knew a lot about the people who lived in the home. They helped the people who live there in a dignified and respectful manner. Staff managed medication well. The home obtained the views of the people who lived in the home and their relatives to make sure that it was doing a good job or to decide how it can change things to make it better for everybody. This gives service users a voice that is listened to about their home. The home had been awarded part 1 and part 2 of the Local Authority Quality Development Scheme for ensuring care plans and a quality monitoring system was in place. People who lived at the home stated they liked the meals and drinks provided. They said they had plenty to eat and they always had choices at each meal with fresh fruit and vegetables. Staff members spoken with were knowledgeable about how to protect vulnerable people and any complaints were looked at straight away and sorted out. The training made available to staff is appropriate for the work that they perform including nursing tasks and takes place on a regular basis. The home had a lot of staff that had completed specific training to care for older people. The way the home recruited new staff followed policies and procedures and checks were made to make sure they were appropriate to work with vulnerable people. The home kept safe peoples personal allowance held for them and documented when purchases were made or when relatives deposited money into the home for safekeeping. Although the home provides good quality of service to people who live there slight improvements in some areas will ensure that this is enhanced even further. What has improved since the last inspection? The requirements issued at the last inspection had been met. Care plans and risk assessments had been improved. Policies and procedures had been updated. A new fire alarm system has been installed. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 7 Some areas of the home have been redecorated and some bedrooms provided with new furniture and carpets. New purchases have been; chairs for the lounge, some pressure relieving mattresses, two beds and a flat screen television is due to be installed in the large lounge. The way staff members support service users to eat at mealtimes has improved. What they could do better: The provider must make sure that the documentation given to prospective service users about the home contains all the information they need in order for them to decide if the home is right for them. The home completed assessments of peoples’ needs prior to admission but they could be expanded on to reflect to what degree any problem affected people and how much support they would need to have. The manager also needs to check the service users files and make sure that people funded by the local authority have an assessment completed by them. Some people sat in chairs that restricted their movement because they were perhaps at risk of falling. The manager needs to make sure that the people have a professional seating assessment to see if what they have is the most appropriate form of seating for them. There were some activities carried out on a daily basis in the home and also occasional outings. It was clear that the activity coordinator tried hard to meet peoples’ needs. However some people spoken with stated the activities on offer did not meet their expectations fully. Also people with dementia may need specific activities tailored to their abilities and needs. The manager needs to look at completing social needs assessments and documenting in an easy way when people don’t participate. This will enable them to see at a glance whether people are just choosing not to join in or if the home is providing the right activity for them. The home has been using agency staff to cover vacancies. The manager needs to make sure that the home has the correct number of staff required to meet peoples needs and that the recruitment of permanent staff is completed quickly. This will provide consistency of care for service users. The manager needs to make sure that staff members have the required amount of formal supervision each year. This will enable their practice to be monitored and their training needs identified. The home had regular fire drills to keep staff up to date but they did not record the response time and which staff members were present. This would enable Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 8 the manager to see if there are any improvements that could be made and ensure all staff participated in fire drills. The manager should apply for registration with Commission as soon as possible and complete the management qualification required for her role. 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 House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home did not produce full information about the services it provided. This means that prospective service users would not be supplied with all the information they need to make a decision about the home. People had assessments of need completed by the home prior to admission. The basic information on the homes in-house assessments and the system of not always obtaining those completed by care management could potentially affect the decision-making about whether they could meet needs. Visits and trial stays were offered to prospective service users so they could assess the home before deciding on permanent admission. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 11 EVIDENCE: The homes statement of purpose and service user guide did not contain all the information as required in the care homes regulations and national minimum standards. These documents clearly set out what is required and the provider must ensure all the points are included. This will ensure prospective service users, and commissioners of services, have full information at hand to decide whether the home is appropriate for their needs. We examined four care files during the visit. Three had assessments completed by the manager or deputy manager in the persons’ own home or hospital, prior to admission to the home. One of the homes assessments was not completed fully and a forth, completed prior to the new manager taking her post, could not be located. The homes assessments could be expanded on to provide more comprehensive information on which to build plans of care and to enable a decision to be made about whether the home was able to meet needs fully. However in discussion with the manager they were very clear about the level of need they were able to support within the home. There was evidence the home generally obtained assessments and care plans completed by care management, as these were evident in three of the files of examined. The local authority assessment information was important to enable the manager and staff team to decide whether the person’s needs could be met in the home. The manager needs to develop a letter to be sent to people following the initial assessment formally stating their capacity to meet identified needs. Prospective service users and their families can spend time at the home talking to people who live there, meeting the staff, enjoy a meal or spend the day there. The home also provided a respite service for short breaks. The manager confirmed that the first twelve weeks of admission was seen as a trial period and any time after six weeks a review could be held to decide if the placement was to be permanent. This allowed people to make their own minds up about whether or not Sutton House was where they wanted to live. The home does not provide intermediate care services. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs were planned for and met in ways that respected their privacy and dignity. EVIDENCE: Four care plans were examined in detail and two further care files were looked at to assess a wound care plan and a self-medication risk assessment and plan. The home had detailed plans of care in place that described the needs of individuals clearly and demonstrated to staff how these needs were to be met. The care plans reflected the content of the assessment, the ones for people requiring nursing care being much more comprehensive than those for people receiving residential care. Information about the persons’ social interests, likes and dislikes, spiritual needs and wishes regarding death and dying were all included within the individuals care plan. The manager described a new process that they were Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 13 going through for each service user in turn to produce more detailed personal management plans putting the service user at the centre of the planning. We saw one of the completed plans and it was good person centred planning, which will only enhance the care plans already in place. During discussions staff demonstrated that they had a good working knowledge of people’s needs. Care plans were evaluated monthly and they indicated changes in need. Some of the evaluations gave instructions to staff, which need to be inputted into the care plans as these are the working documents and are what staff read to gain knowledge about the person. The care plans indicated that people’s health care needs were met and there were referrals to health professionals for advice, support and treatment, for example, district nurses, continence advisors, dieticians and physiotherapists. People said that they could see a GP when they wished and the home organised this for them. Records showed assistance was given to attend health care appointments to the chiropodist, the optician, the dentist and outpatient when required. There was evidence that peoples weight was measured on a regular basis in order for the home to monitor nutritional needs. Those care files seen demonstrated that peoples’ weight had remained stable or had increased. One care file examined showed a comprehensive wound care plan, which detailed the treatment provided and progress made in healing the wound. Generally care plans were signed by the individual or their representative to show that these had been discussed and agreed. One or two signatures were missing by the person formulating the care plans. Risk assessments were seen to cover pressure damage, nutrition, moving and handling and specific activities of daily living for individual people. A number of people were using a type of chair that reduces their chances of falling and sliding out, however they also prevent them moving independently. The individuals concerned had a risk assessment in their plan to indicate the reason for using this form of restraint and it had been discussed and agreed by them or their representative. However other than for one person, there was no record of an initial assessment regarding the need for the chair completed by a professional occupational therapist or physiotherapist. A seating assessment needs to be completed for the service users to make sure these chairs are the most suitable form of seating to meet their needs. People spoken with said that staff treated them kindly and that care was, ‘good’. Members of staff were observed being friendly and chatting to people with respect. In discussion with staff about maintaining people’s privacy, they spoke about the need for sensitivity when carrying out personal care tasks, to knock on people’s doors prior to entering and to ensure curtains and doors were closed when required. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 14 The home managed medication well. It was stored and recorded appropriately and those who administered medication were trained nurses. During the visit the home had an assessment completed by the community pharmacist and received only two minor recommendations as a result of this. One person was able to self-medicate. They had a risk assessment and care plan for this and had been provided with a lockable facility to store the medicines safely. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service users were provided with the opportunity to become involved in activities at the home and in the community. Assessments of their social needs will enable the staff to tailor activities to meet individual wishes and abilities. Visitors were made to feel welcome in the home. Service users were provided with good quality, varied meals that were appropriate to their needs. EVIDENCE: The provision of activities was one area that the manager agreed they have not got quite right yet for everyone. Surveys from residents confirmed this with only one person stating there were sufficient activities, ‘always’, two stated, ‘usually’, two stated, ‘sometimes’ and the last two stated, ‘never’. One relative said, ‘they need to arrange more activities’ and staff in discussion Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 16 stated there were not too many activities going on. The home had a programme of events on display on the notice board. In discussions, people told us there were activities such as, quizzes, beanbag games, arts and crafts, nail care, sing-a-longs, visiting entertainers, some outings to local venues and shops and seasonal activities. The home employed an activity coordinator that was quite new in post. There was some evidence that information was gathered about peoples likes, dislikes, hobbies and interests and the manager confirmed the activity coordinator was working on, ‘life story’ information with the help of some family members. One person received talking books and the small sitting room was stocked with books. There needs to be social needs assessments completed to establish peoples abilities to participate in activities of their choice and what support they may require to make this happen. This will enable a programme of social events and stimulation to be tailored for each individuals needs. The activity coordinator documented when people participated in activities and it was suggested that a monthly, ‘at a glance’ record could better inform who had not participated in order to address why this happened. People spoken with stated that their relatives could visit at any time and were offered refreshments when they did. A survey from a relative stated, ‘It’s a homely atmosphere’ and both relatives stated they were kept informed about important events. People could see their relatives in private in their own bedrooms or in communal areas. Information from the residents’ files indicated that there were a number of individuals who followed different spiritual faiths and regular church services were held within the home. The manager confirmed that children from a local school visited the home recently at Christmas to perform a pantomime and one service user spoke of staff taking them to a local pub. The newsletter evidenced that various community events had taken place in November and December. People confirmed there were no fixed times for getting up and going to bed and it was clear that people had some opportunity to make decisions about aspects of their lives. One of the staff members spoken with did state that sometimes, due to staffing issues, peoples’ choice about retiring to bed was not always adhered to and they went to bed later than they would choose to. This was mentioned to the manager to check out and resolve. Some people managed their own money and bedrooms were personalised to varying degrees with people able to bring in their possessions to make their bedrooms homely. People liked the meals provided and food sampled on the day was well prepared and presented. Menus rotated over a period of four weeks and included a cooked breakfast, two choices for the main meal at lunch and hot Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 17 and cold items at teatime. Service users were also provided with supper consisting of sandwiches, toast, cakes, and cheese and crackers. The cook recorded the meal chosen by people and used a symbol to signal whether they enjoyed it. The home had recently scored ‘B’ from the local environmental health officer for the way they managed food preparation. The kitchen staff made an effort to provide soft/pureed diets in an attractive way, vegetarian options were available and special diets were catered for. Fresh fruit and vegetables were available and the cook advised they used very little frozen food. Comments about the meals were, ‘the food looks appetising’, ‘my husband likes most of the food’, ‘we have good meals’, ‘they come around and ask us what we want, the food is very good’, ‘its always soft so I can swallow it properly’, ‘I have my breakfast brought to me in my bedroom’ and ‘they would do different food if you didn’t like it’. Members of staff were observed supporting people at lunchtime and one staff member in particular was very attentive, explaining to the person what was for lunch that day, checking out if they were enjoying the meal and supporting at a steady pace. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 18 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): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided an environment where people and their relatives felt able to complain. The home protected service users from abuse by staff training and adherence to policies and procedures. EVIDENCE: The home had a complaints policy and procedure that was on display in the foyer. A complaint form was available for staff and complainants to complete, which detailed the issue, the action taken and the outcome. Those complaints received were of a minor nature and had been resolved. People spoken with stated they felt able to complain if they were unhappy, ‘I would go to the office, to the matron Tracy, I have no complaints at the moment’, ‘I don’t see the matron that often, well I see her once a day, I would tell other staff’ and ‘I would tell someone if I was unhappy’. All seven surveys received from service users and the two from relatives stated they knew how to complain. One relative stated in a survey, ‘matron has an open door’. The Commission had received two complaints since the last inspection. One regarding staffing levels was passed to the provider to investigate and the Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 19 second, regarding the care received by a service user, was referred to the local authority. The social service team carried out the latter investigation and the concerns were resolved successfully. There is still a staffing issue in the home at times and this is discussed more fully in the staffing section of this report. The home used the local authority policies and procedures for the protection of vulnerable adults from abuse. We spoke to fifteen staff throughout the day and all stated they had received training in how to safeguard adults from abuse. They were knowledgable about the types of abuse and the alerting, referral and investigation process. The manager confirmed that all staff bar very new ones had received safeguarding training. The manager had completed the managers training provided by the local authority and was aware of how to refer any allegations to the lead agency responsible for investigation. She has been asked to work with the local authority to be a core trainer in safeguarding and give presentations to other providers. The manager evidenced her awareness of the policies and procedures via a recent referral to the safeguarding team about the care provided to a service user. A review of the care was called and the issue resolved. The homes recruitment practices were robust and ensured via selection, interview, references and police checks that only appropriate staff members were recruited. Since the last inspection the home had produced a new policy and procedure for the safe management of service users finances. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 20 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): 19, 20, 24 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and safe environment for those living, visiting and working there. People had the opportunity to personalise their bedrooms, which made them feel more at home and enhanced their feeling of wellbeing. EVIDENCE: The manager had a record of the ongoing maintenance and renewal programme within the home and this indicated that the provider was committed to improving the facilities and the environment within the home. Since the last inspection purchases include some pressure relieving mattresses, two new beds and new chairs in the lounge and some bedrooms. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 21 The development plan for Sutton House for 2007/8 indicates an intention to convert the unused bathroom on the second floor into another shower facility, and purchase a shower trolley for use by the physically disabled residents. This was in the development plan for 2006/7 but had not been completed. However there were several large items purchased and several areas redecorated during that year. Communal areas consisted of a large lounge divided, since the last inspection, into distinct areas, a small sitting room, a large dining room and a quiet sitting area in the foyer. The home had a large garden with mature trees and shrubs, a patio area with furniture and ample space for parking. The home was decorated in pale colours with appropriate furnishings and lighting. The home had eight shared bedrooms and three single bedrooms on the first floor and seven shared and five single on the second floor. All bedrooms had a separate room with en-suite facilities consisting of a toilet and washbasin. People were encouraged to bring in small items of furniture, pictures and ornaments to personalise their bedrooms and this was seen to varying degrees. The bedrooms had privacy locks and lockable facilities for the storage of valuables. People spoken with were happy with the home, ‘I’ve got my own bedroom and en-suite, everything is there’ and ‘the home is clean, the domestics work hard’. Seven surveys received from service users all stated the home was clean and free from odours. One relative stated, ‘the house is well kept’. The home had two bathrooms and a shower room on the first floor and two bathrooms on the second floor. Each bedroom had a toilet and there were sufficient toilets close to communal areas. The environment was clean, warm and comfortable and no malodours were present. Comments from the surveys indicated that the residents were satisfied with the laundry service provided by the home, ‘the laundry is very good, it doesn’t go missing’. Sutton House Nursing & Residential Home DS0000062875.V358330.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A reliance on agency staff could lead to inconsistent care and support for service users, and permanent staff feeling rushed. The home ensured that staff received the training required to carry out their caring and nursing tasks. Staff demonstrated a clear understanding of their roles and knew the service users needs well. The recruitment processes ensured only appropriate staff were employed to care for vulnerable people. This helped to secure the safety of people that live in the home. EVIDENCE: Discussions with the staff team and information included in surveys from them indicated that there were some staff issues to resolve. Generally there were five to six carers on duty during the day and one nurse, but sometimes this has been four carers and a nurse, causing staff to feel very rushed. At night the home usually has three carers and a nurse, however the home is short staffed of qualified nurses at night and this has caused difficulties. Care staff stated that at times there has been two care staff and an agency nurse on duty that is not fully familiar with the service users. Staff members feel very Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 23 stretched at these times and unable to spend quality time with people. One staff member stated in a survey, ‘more staff is needed to sit and listen to people not just provide basic care’. The manager is fully aware of the issue and is trying to recruit more night nurses. A newly appointed deputy manager filled in for a short while but the situation is still ongoing until recruitment is complete. Staff stated in discussion that the situation was affecting morale and it was increasingly difficult for them to work in two’s during the night, as they feel is required for the needs of the service users. Comments from service users spoken with during the day and surveys received from them were that staff were kind, answered bells quickly and looked after people well. One person stated, ‘I have spent six and a half happy years here’ whilst another said, ‘the home is very supportive and communication is good’. Five of the surveys indicated that staff listened to people, ‘always’, whilst two stated this happened, ‘sometimes’. The two surveys received from relatives were also positive about the staff, ‘most staff are very helpful’ and ‘the staff foster a happy atmosphere’. One relative did comment that an improvement would be to have more staff available and another commented on the difference in skills between permanent staff and agency staff. The manager confirmed they had recently recruited two kitchen assistants that were due to start soon making the home fully staffed with ancillary workers. The home had a good training plan that covered mandatory and service specific courses. Of those fourteen staff members spoken with during the day, all had completed fire, safeguarding adults from abuse and moving and handling. Several had completed infection control, health and safety and basic food hygiene, and four had completed a distance-learning course on dementia care. The manager had developed contacts with other professionals and had arranged in-house sessions for a variety of conditions affecting the people that lived in the home. For example, wound care, nutrition, medication, caring for people affected by strokes and diabetes, enteral feeding for people who only have their food via a tube, and caring for the deceased with dignity. Other courses to be arranged were continence care, palliative care and catheter care facilitated by, respectively, the continence promotion advisor, McMillan nurses and the home manager. The home also had access to a range of training provided by the local authority, and privately commissioned training for fire safety and safeguarding adults from abuse. Induction for new staff had been an orientation to the home and working alongside more experienced staff. However new staff members had started the skills for care induction standards but these needed to be followed up and ensured that evidence was produced as they worked through each section of the common induction standards booklet. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 24 Two staff surveys received stated they received training that was relevant, kept them up to date and helped them understand peoples’ needs. One stated the induction they received was very well done, whilst the other stated this was done partly. Staff spoken with on the day confirmed they completed skills for care booklets by Mulberry and had access to support via a mentor system. Sixteen out of twenty-six care staff had completed National Vocational Qualification training at level 2 and 3 and three were progressing through the courses. The current position means that 69 of care staff members, which includes the six qualified nurses, are trained to this level. This exceeds the standard and is a very good achievement reflecting the staff members’ commitment to training. Files of the five latest members of staff to be recruited were examined and all contained application forms, two written references, protection of vulnerable adults register checks and enhanced disclosures from the Criminal Records Bureau. The manager was clear that the company had a policy of only starting people on shift after the return of a satisfactory criminal record bureau check. This robust recruitment system ensured that only suitable members of staff were employed to work with vulnerable people. Some photographs of new staff were required for the records. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 36 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally the home is well managed. Full implementation of the supervision plan will ensure that all care staff members receive adequate monitoring. EVIDENCE: The new manager has been in post for eight months and is a Registered General Nurse. She is currently sourcing management training at the required level, for example the Registered Managers Award but will be exempt from the care element because of her nurse qualification. Prior to her current role the manager was a district nurse. She has yet to apply for registration with the Commission. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 26 Staff members spoken with stated they could go to the manager and talk to her about issues but they stated they did not always receive feedback. They were aware that the manager was very busy at the moment, as the deputy manager was unavailable. There also appeared to be some confusion between night and day staff and their separate roles resulting in the appearance of two teams rather than one team with the same aim of meeting the needs of service users. This was passed on to the manager to speak to staff and address. Staff attended meetings and had the opportunity to express their views. Staff members stated they were aware that the area manager visited the home but not many had had the opportunity to sit and talk to them. This was mentioned to the manager to pass on, as a requirement under regulation 26 of the care homes regulations was that the provider must interview people working in the home in order to form an opinion of the standard of care provided. The manager had developed a good system of monitoring the home and the service it provided and she had based this around the national minimum standards. Audits were completed and questionnaires had been sent out to service users and relatives. Results had been analysed and an action plan produced to address the shortfalls. There was evidence that the views of service users had been listened to and followed through. The manager had also completed an annual quality assurance assessment required by the Commission. Questionnaires had been devised for professional visitors but had not been sent out to them yet. An annual, month-by-month quality assurance plan would help the manager structure the process more clearly, however the home had achieved both parts of the quality development scheme awarded by the local authority for quality monitoring. Relatives or people themselves managed finances although the home held in safe keeping a small amount of personal allowance for twenty-one people. This was usually for small purchases, hairdressing and chiropody. It was held securely in the safe and managed and recorded appropriately. Relatives received information monthly to enable them to check what had been withdrawn. People had lockable facilities in their bedrooms to store items should they choose to. A staff supervision plan had been devised with the manager and deputy manager supervising nursing staff and the nurses supervising both levels of care staff. There was some evidence that formal one to one supervision had been provided for some staff but this was inconsistent. The manager was advised that staff must have at least six supervision sessions a year. Staff had received appraisals in the past and the manager was to ensure these were restarted. It was acknowledged that the manager had been completing both her own tasks and those of the deputy manager since their absence and this had led to supervision getting behind. This should be resolved in the near future. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 27 Generally the home was a safe place for people to live in and staff to work in. Documentation indicated that moving and handling equipment was serviced regularly and fire drills and alarm tests completed. Fire drills need to indicate the response times and the staff members present to alert to any shortfalls in response. Staff had policies and procedures to guide their practice and safety posters were on display in the home. It was noted that the wheelchairs had been stored without footplates and one service user was seen using a wheelchair without the footplates insitu. This was mentioned to staff and the manager. The footplates were all present but need to remain on the wheelchairs so staff members do not forget to use them. The sluice room needs to remain locked when not in use. Maintenance staff record the tasks completed each day and there was evidence that issues were dealt with straight away. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 28 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Requirement The registered person must ensure that the homes statement of purpose and service user guide contains all the required points in line with schedule 1 of the care homes regulations and national minimum standard 1.2. This will ensure that prospective service users have full information about the home before deciding on admission. The registered person must ensure a comprehensive needs assessment is completed for all service users and copies of care management assessments and care plans are obtained for all people funded by them prior to admission. This will ensure the home has full information in order to make a decision about their capacity to meet the identified needs. The registered person must confirm in writing that having regard to the assessment, the home can meet the assessed needs. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 30 Timescale for action 31/03/08 2 OP3 14 29/02/08 3 OP8 14 4 OP12 16 5 OP27 18 6 OP36 18 The registered person must ensure that the service users who sit in Kirton chairs, which prevent people from standing up independently, receive assessments from professionals qualified to complete them to ensure these are the most appropriate form of seating for them. The registered person must ensure that social needs assessments are completed to enable a plan of activities to be produced, which is tailored to individual needs and abilities. The registered person must ensure that staffing levels in the home remain constant and the reliance on agency staff reduced through robust recruitment. This will ensure that service users receive consistent care from people that know them well. The registered person must ensure that care staff members receive formal one to one supervision at least six times a year. This will ensure staff practices are monitored. All staff to have at least one supervision session by timescale for action date. 29/02/08 31/03/08 29/02/08 31/03/08 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 Refer to Standard OP31 OP31 Good Practice Recommendations The manager should apply for registration with the Commission as soon as possible. The manager should complete the management modules DS0000062875.V358330.R01.S.doc Version 5.2 Page 31 Sutton House Nursing & Residential Home 3 4 OP33 OP38 of the Registered Managers Award or equivalent. An annual, month-by-month quality assurance plan would help the manager structure the process more clearly. Noting the fire drill response times and staff members present after completion of fire drills will give a clearer picture of any shortfalls in this area. Sutton House Nursing & Residential Home DS0000062875.V358330.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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