CARE HOMES FOR OLDER PEOPLE
Sutton Manor Priestsic Road Sutton In Ashfield Nottinghamshire NG17 2AH Lead Inspector
Steve Keeling Mary OLoughlin Unannounced 16 August 2005 14:00
th 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 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 Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Sutton Manor Address Priestic Road Sutton In Ashfield Nottinghamshire NG17 2AH 0162 355 1215 0162 344 1150 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashmere Care Homes Mrs Barbara Guinnane Care Home - Private 45 Category(ies) of OP Old Age 45 registration, with number of places Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 06.03.05 Brief Description of the Service: Sutton Manor Residential Home is part of the Ashmere Care Group. The home is situated on Priestic Rd Sutton In Ashfield, Notts. One of three Care Homes based on the site close to the town centre and community facilities, the home provides 45 beds offering personal care for older people 65 plus. The home provides en suite facilities to the majority of rooms. The accommodation is provided on two floors. The home offers an intermediate care service with 5-10 beds for rehabilitation. The aim of the residential intermediate care scheme is to provide a safe environment within a residential setting for people who would otherwise face unnecessary prolonged hospital stay, inappropriate acute hospital admission or long term care. Through the provission of specialist intervenions by a multidisiplinary team individuals are given the opportunity to maximise their potential when carrying out activities of daily living. The home has large garden facilities that are well maintained and easily accessible to the service users. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a 2.5 hour period and involved two inspectors. The main method of inspection was case note tracking, this is a method of selecting service users within the home and discussing with them their expectations and experiences of living within the home environment. The case tracking method also analyses the records of the service users to ascertain if the service users identified needs are being addressed appropriately within the care home setting and that their safety and well being is being maintained. On this occasion four residents notes were case tracked. Also as part of the case tracking process, staff within the home were informally interviewed to further evidence the quality of care afforded to the service users. At the time of the inspection a total 35 residents were accommodated at the home. It was evident that the management and staff within the home are committed to providing a high standard of care to the residents. The manager within the unit was very helpful and cooperative thus ensuring that the inspection process progressed in a professional and efficient manner. What the service does well:
Sutton Manor offers a pleasant well-maintained environment for service users. Management and staff within the home are committed to providing an environment that is conducive to achieving optimum independence and comfort for the service users. A comprehensive “in house” training package has been established in an attempt to promote the safety and well being of the service users. All aspects of medicine management and administration in the home are effective in ensuring safety for the service users. Service users benefit from a comprehensive range of social activities within the home and a mini bus is available for trips out into the community.
Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 6 The home has a programme of routine maintenance in place to ensure that any shortfalls in the standard of the immediate environment are dealt with effectively and efficiently. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 It is evident that minor inconsistencies exist in relation to the Pre admittance assessment process and care plan formulation. One case tracked service user had been admitted to Sutton Manor from the Residential Intermediate Care Scheme (RICS) without having a full assessment of needs and no care plans had been produced which could place the service user at risk. EVIDENCE: Three of the service users who were case tracked on the day of inspection have been residents in the home for many years and although the preadmittance assessments had been performed they were stored in the loft due to limited space in the managers office. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 9 Sutton Manor accommodates a Residential Intermediate Care Scheme (RICS). The aim of the scheme is to provide a safe environment in a residential setting for people who would otherwise face unnecessary prolonged hospital stay, inappropriate acute hospital admission or long term care. This is achieved by offering a safe environment for rehabilitation, that involves an opportunity for recovery within a six week period. The scheme provides a maximum of ten beds for constant usage and once the service user has received rehabilitation they will be discharged home or into a residential/nursing care environment. A service user who had been discharged from the RICs Scheme resently to the care of Sutton Manor only had a moving and handling assessment and 1 care plan relating to the aforementioned moving and handling assessment. It was evident that this initial assessment had been performed whilst on the RICs scheme. No risk assessments or care plans had been formulated for this particular service user when she was transferred from the RICs Scheme to the care of Sutton Manor. The manager reported that she felt that the service user was not at risk as the manager stated that the staff were fully aware of the needs of the service user through previous operational meetings and weekly meetings with members of the RICs team. It was agreed that this was an oversight by the manager of Sutton Manor and was addressed straight away . Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 Shortfalls in the care planning process were evident and service users health care needs are not fully met as a result of this shortfall. Service users are at risk of cross infection because of inappropriate procedures regarding blood glucose monitoring. EVIDENCE: Four services users care plans were examined on the day of inspection. Three of the care plans examined were extensive but they lacked specific detail on how the care was to be provided to the service user. In performing the case tracking process some difficulty was experienced. Risk assessments, care plans and pre admittance assessment were stored in separate files within the managers office and in the loft, this system could result in confusion and effect the care afforded the service users. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 11 No evidence of the involvement of service users or relatives was evident in the care plan formulation, a signature of the service user or relative in relation to agreement of care plans is required as evidence that a consultation has taken place. The homes policies and procedures in relation to dealing with medicines are effective. All members of staff involved in the administration of medicines have received training. It was evidenced that the last training day was in July 2005 and 7 care staff were enrolled on the event. Medicines are recorded into and out of the home and are audited daily. The medicine trolleys are well organised and clean and photographic images of the service users are present on the MAR charts so as to avoid misadministration of medication. The medication fridge was well organised and temperatures were recorded on a daily basis to ensure an optimum storage environment is achieved. An effective clinical waste and “sharp” collection and disposal system was evident. Equipment used for obtaining blood for blood glucose monitoring was not “single service user only” which would present a potential treat the service users in relation to cross infection. An immediate requirement was made to ensure this shortfall is rectified. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15 Service users have the opportunity and choice to participate in varied and stimulating social activities. Service users are provided with a wholesome, appealing and balanced diet. EVIDENCE: Service users interviewed were very well presented and were very happy in the home environment. They stated that they could spend the day “pretty much as they pleased” and the staff within the unit were very attentive to their needs. Service users stated that varied social activities take place within the home such as bingo, sponge darts, movement to music, and often guest singers and an organist are performing in the home in the evenings. A minibus is available and it was confirmed that the residents had recently been taken to Skegness for the day and also a trip into Derbyshire had recently been undertaken. The home also organises boat trips from Newark on Trent, which the service users enjoy. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 13 Although an activities coordinator was not employed within the home a resident specific, activities log is available which clearly demonstrates service user preference thus ensuring the service user has a choice in relation to social activities. The social log also documents when social activities have been undertaken by the service users. Service users stated that ‘the food in the home is lovely and we often get too much at times’. The manager ensures that weekly menu sheets are available for service user perusal and on examination it was evident that a varied selection of meals was available throughout the day. A requirement from the previous inspection was to ensure that all food should be probed and that the temperature of the food should be documented, it was evidenced that this is now taking place and daily food temperature records are now being maintained reduce the risk of bacterial infection to the service users. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home has effective Adult Protection procedures and policies, which includes a Whistle Blowing policy to protect service users. EVIDENCE: It was evidenced that all members of staff have received a comprehensive induction programme and a full and varied ongoing “in house” educational programme is in place. Staff personal files evidenced training courses attended that specifically relate to protecting the vulnerable adult from abuse. The courses pertinent to the protection of the vulnerable adult includes an induction into care, abuse training day, challenging behaviour training day, visual impairment training, health and safety, moving and handling, first aid, food hygiene, COSHH and training in the correct administration of medicines. Pre employment screens are performed for all new members of staff, which satisfies the legal requirements identified in the Care Standards Act 2000. Documentary evidence in relation to re-employment checks are available within staff files. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25,26 The location and layout of the home is conducive to achieving the statement of purpose. It is well maintained, clean, homely, well equipped and appropriately furnished. A programme of routine maintenance is in place and all documentation in relation to maintenance is very well managed and maintained. EVIDENCE: The home has an ongoing routine maintenance programme and a dedicated handyman deals with any shortfall within the home environment effectively. The grounds are tidy and well maintained and easily accessible to service users thus providing a very pleasant areas for the service users to utilise on hot days The home has a high standard of cleanliness and smelled fresh. The handyman performs and records weekly fire tests, ensures that hot water is regulated at all outlets and water chlorination is performed and documented to control Legionella contamination.
Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.29. The staff recruitment and induction process is robust thus protecting the service users from potential abuse. On occasion the levels of staff employed within the unit is not sufficient to meet the needs of the residents. EVIDENCE: On the day of the inspection 35 service users were accommodated at Sutton Manor. Staffing levels were appropriate to meet the needs of the service users. Duty records show that sickness and absenteeism can leave the home with insufficient staffing levels to meet service users needs. An immediate requirement was issued in relation to this matter at the time of the inspection. It was reported by the manager that she was in the process of appointing two new day care assistants and two new night care assistants in an attempt to ensure that staffing levels are always maintained at an appropriate level. Staff files evidenced that recruitment policies and procedures are followed and that all required checks and references are obtained prior to employment. It was evidenced that the four new members of staff are currently awaiting P.O.V.A first checks before commencing employment. Training documentation was very well maintained and efficient in tracking staff’s progress through the induction and training programmes. Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 31-38 were not assessed at this inspection EVIDENCE: Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x x x x Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Service users plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet the health and welfare needs of the service users. Service users plans must be kept under review The registered person must ensure that devices for obtaining blood samples in relation to blood glucose levels are single resident use only Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and well being of the service users. Timescale for action Immediate 2. 9 13 Immediate 3. 27 18 Immediate 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.
Sutton Manor C53 C03 S8807 Sutton Manor V244647 160805 Stage 4.doc Version 1.40 Page 20 Refer to Standard Good Practice Recommendations Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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