Inspection on 20/05/08 for Sutton Oaks Care Centre

This inspection was carried out on 20th May 2008.

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

The inspector 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 Oaks Care Centre 28/10/08

Sutton Oaks Care Centre 20/11/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Sutton Oaks Care Centre Sutton Oaks London Road Oak Grove Macclesfield Cheshire SK11 0JG Lead Inspector June Shimmin Unannounced Inspection 20 and 21 May 2008 09:20 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 Oaks Care Centre DS0000069629.V363589.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 Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sutton Oaks Care Centre Address Sutton Oaks London Road Oak Grove Macclesfield Cheshire SK11 0JG 01260 253 374 01260 253 319 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) Canterbury Leased Homes Limited Care Home 55 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (55), of places Physical disability (10) Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 55). Physical disability: Code PD (maximum number of places: 10). Dementia over 65 years of age: Code DE(E) (maximum number of places: 10). The maximum number of people who can be accommodated is: 55. Date of last inspection 20 November 2007 Brief Description of the Service: Sutton Oaks was built in 1875 as a private house for a local mill owner. The original house is a listed stone building that has been used at various times in its history as a convalescent home for war victims and a local authority residential home. The previous owners converted it into a care home providing nursing care in 1992. It is now run by Canterbury Care Homes Limited, which took over as the new owner in June 2007. Sutton Oaks is approximately three miles from Macclesfield town centre and is on a local bus route. It is a three-storey building, with an extension to the older building, surrounded by gardens and woodlands. There are a number of communal living areas, including lounges and dining rooms, over all three floors. There are 27 single bedrooms and 13 shared rooms. All but three of these have en suite facilities. Access for people who use wheelchairs is generally good. There are two passenger lifts, four internal staircases and an external fire escape. The home is registered to care for people who require nursing care or who have dementia. It is staffed with registered nurses at all times. They are supported by a care staff and there are staff for catering and cleaning. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 5 Room prices range from £518.37 to £800 per week, depending on the size of the room and whether it is a single or double and the type of en-suite facilities. Sutton Oaks can provide respite care if beds are available. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 0 stars. This means that the people who use the service experience poor quality outcomes. An unannounced visit to the home was carried out on 20 and 21 May 2008 by one inspector. The visit lasted 10 hours over the two days. Before the visit the manager was asked to provide information about the home as part of this inspection process. CSCI questionnaires were also sent out to people who live in the home, their families, staff and health and social care professionals such as social workers in order to find out their views. Other information received since the last key inspection was also reviewed. During the visit, various records and the premises were looked at. We talked to five people living in the home and three relatives and gained their views about the care and services that are provided. We spoke to seven staff members and a social worker for a person who lives at the home. Their views are incorporated into the findings of this report. The former manager of Sutton Oaks was present during our visit as there is currently a vacancy for the post of manager. The former manager was given feedback at the end of the inspection. What the service does well: Relatives hold staff working at the home in high regard. Comments such as ‘they’re doing the best they can’ and ‘everybody does their best’ were made. Care home staff refer people with additional health care needs to a range of health care professionals in a timely manner so that those needs can be dealt with promptly. Visitors are made to feel welcome at the home. Complaints are recorded and actions taken to investigate complaints and put right any matters so people know their concerns are being listened to. The sums of money kept on behalf of people living in the home are well managed so they know that this money is kept safe. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The care home staff must ensure there are thorough systems in placed to make sure that people who are at risk of weight loss are monitored and action taken to prevent further weight loss and a further deterioration in their health. Measures must be taken to ensure that medication is administered and disposed of in a safe manner and that medication prescribed for people is obtained in a timely fashion so that people receive the medication they need. Staff must observe the privacy and dignity of people living in the home at all times so that the basic principles of good care are met. All staff must undertake training in the protection of vulnerable adults so that they know how to recognise abuse and what to do if they suspect someone is being abused. Sufficient numbers of care and cleaning staff must be employed at the home so that people’s needs are met and the home is kept clean. Two references must be obtained for all staff working at the home and proof of nurses’ competence to practise to make sure that staff working at the home are suitable to work with the people who live there. Records of all training and induction undertaken by staff must be provided to show that they have undertaken training appropriate to their role and have the skills to provide care to vulnerable people. The owners must appoint a suitably qualified person to manage the home and to make sure that it is well run in the best interests of the people who live there. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 8 All staff working in the home must undertake fire safety training and take part in fire drills so that they know what to do if fire breaks out. Staff involved in moving and handling procedures must undertake suitable training so that people are moved safely and staff are also protected. The owners must inform the CSCI of any notifiable events in the home without delay as required by law. 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 Oaks Care Centre DS0000069629.V363589.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 Oaks Care Centre DS0000069629.V363589.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): 3 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Although an assessment of people’s needs is carried out before they move into the home to find out if their needs can be met there, some people have care needs that the staff have not been trained to meet. This means that those people’s needs may not be fully met. EVIDENCE: The assessments of three people who had recently moved into Sutton Oaks were seen. The previous manager had assessed all three people. The assessments included information about the physical care needs of these people but there was limited information about the ability of each person to communicate and understand, which is important for staff to know when caring for someone with dementia or any degree of cognitive impairment. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 11 In addition, there was very little or no information about the social, family, work and spiritual needs of these people so that these needs would not be known by care staff and suitable care plans could not be provided. This issue was raised at the previous key inspection. In one case, a care home where one person had formerly been accommodated forwarded an excellent person centred care plan about the person. Very little of the information in this plan had been included in the care plans drawn up by Sutton Oaks staff. The former manager said that the families of people living in the home were given a form to fill in about the person so that this information could be obtained and people could be given care that was person centred and tailored to their individual needs. However, it appeared this was not followed up so that if families did not complete the form then this information would not be obtained. Several care staff were asked about their knowledge of the needs of people in the home. Their knowledge appeared to be limited and mainly focused on the physical care needs of people so that they would not be able to provide person centred care. Staff said that they had not been working on that unit long or worked on both units depending on staffing levels in the home. Sutton Oaks Care Centre DS0000069629.V363589.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 this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. The health care needs of people who live in the home are not always well managed so their care needs are not fully met and their privacy and dignity may not always be respected. EVIDENCE: The care plans for three people who live in the dementia care unit were seen. A nurse assessor reviewed five care plans on three separate days during May 2008 and provided feedback to CSCI about these care plans. A social worker also gave feedback about a care plan that she had reviewed. Many of the care plans were pre printed and staff had added the name of the person to make the care plan specific to that person. However, in many instances the actions in the care plan did not relate to the care needs of the person. For instance, one plan stated that appropriate aids and adaptations should be used but did not specify what these were. Another care plan referred to the Medley tool for the prevention of pressure ulcers, yet the home Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 13 was using a Waterlow score, which is a different tool. The manager said that a new system of care planning is being introduced so that the pre printed care plans will be replaced but this was not far advanced. Care plans were not person centred and were not based on a person’s individual needs. There were a number of care plans that indicated that people were losing weight. Although this may have been partly due to incorrect weighing techniques it was not helped by the fact that the home’s scales had been out of action for some time. The home had referred people with apparent weight loss to the dietician and several people had been prescribed dietary supplements. However, no assessment methods, such as measuring limbs or Body Mass Index, were being used at the home to assess whether the person was underweight or severely underweight. This meant there was no assessment of the severity of weight loss and its overall impact on the person’s health. Information provided by the former manager indicated that five people had pressure ulcers. The last pressure ulcer audit conducted in April 2008 stated that the ulcers of two people had healed but that three people still had pressure ulcers. Appropriate pressure relieving equipment was in place for all five people. The care plan of one person with a pressure ulcer was looked at. Although there were no body maps indicating the location and size of the pressure ulcer, the remaining documentation was satisfactory. The tissue viability nurse had visited and been involved in the management of the pressure sore, indicating that the care home staff had sought specialist advice. The records also showed that people living in the home received support and advice from a range of other health professionals in a timely fashion. Although care plans had been reviewed in some cases this was not consistent so that changing needs were not always documented and staff might not be aware of what those changing needs were. Several staff mentioned that they had very little time to read care plans and therefore depended on verbal handovers so might not be fully aware of people’s needs. Several instances of poor practice were either observed or reported. One person who had recently moved into the home had not received a bath in a period of two weeks since moving in. This situation has now been rectified. The same person was left to eat a meal unsupervised when the original assessment identified that they needed to be supervised. We found a person in bed crying out for a drink at 11am; their fluid balance chart had nothing recorded since 6am. The nurse said that the person had been asleep earlier and so had not been awake to take a drink. Untouched food was found on the person’s bed table and it was not clear whether the person in bed could reach this food. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 14 A visitor told us that another person had been found with an overfull catheter bag and appeared distressed. When assistance was sought the carers did not allegedly seem concerned. The inspector observed one interaction between staff and a person and another instance was reported by a social worker where the privacy and dignity of two different people in the home was not respected. Although medication appeared to be fairly well managed during the inspection visit two separate issues were reported by the social worker and nurse assessor. Liquid medication had been left unattended in the room of one person and medication required by another person had not been obtained for a period of two weeks so the person did not receive their prescribed medication. Sutton Oaks Care Centre DS0000069629.V363589.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 this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The limited range of activities and lack of information about people’s preferences means that their quality of life might be reduced because they cannot take part in social activities of their choice. EVIDENCE: Two people are employed at the home to co-ordinate activities. One of these people works two days a week on the ground floor and the other person works the same number of days on the first floor. There is little or nothing recorded on the initial assessment about individual people’s needs and preferences so the activities being provided may or may not be people’s preferred activities. There is nothing recorded in care plans about how the person’s social care needs will be met and one care plan stated that staff should ‘encourage X to participate in social activities’ without recording what that person’s preferences were. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 16 During the afternoon we observed about six people on the first floor joining in a game of floor skittles for a short period of time, which several people seemed to be enjoying. As care plans were not person centred they also did not indicate what people’s preferences were in relation to their daily lives and did not show if people were able to exercise choice. The social worker reported that a person who had recently moved into the home liked to have a nap after lunch but there was nothing in the care plan to show that the person was offered this choice. They were not seen being offered this choice during the visit to the home. Although the spiritual needs of people were not always recorded in their care plans representatives of local churches visit Sutton Oaks twice a month to offer people spiritual support. A visiting policy written by the previous owners was displayed at one of the entrances to the home. The menus at the home are displayed on one of the ground floor corridors. They are not provided in large print so some people might not be able to read them. The menus are varied and a choice is recorded. One relative told us, ‘not always a choice if she doesn’t like what’s on the menu’ and another ‘not impressed with the overall standard of catering.’ However, another relative was very pleased with the catering and said that the cook personally looked after his wife’s catering needs, which were quite specialised. Two care staff were observed taking hot food round the home on an unheated trolley for the evening meal so food might not be warm enough when it was served. Sutton Oaks Care Centre DS0000069629.V363589.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): 16 and 18 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. There is a complaints procedure and complaints are investigated but staff have not received training on safeguarding adults from abuse so people who live in the home may not be fully protected. EVIDENCE: Sutton Oaks has a complaints procedure, which is contained in information given to people when they move into the home. Relatives were aware of how to complain and said they would know who to speak to if they had concerns. The former manager said that complaints had been investigated and appropriate actions taken. The complaints records were seen. There has recently been an increase in complaints made directly to the CSCI about care standards in the home. There has also been an increase in referrals made in relation to incidents at the home under the local authority’s safeguarding procedures. Investigations into these allegations have been carried out. These have highlighted areas of concerns: staffing levels in the home are inadequate, staff do not receive sufficient supervision from senior staff, staff have not received adequate training to perform their role and the home is caring for people with high levels of dependency and challenging behaviour. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 18 ‘Safety gates’ have been fitted in the bedroom doorways of several people to protect them from other people living in the home who might wander into their room uninvited. This measure should only be used where there is no other means of protecting people and only with the full written consent of people living in the home or their representative and in discussion with social and health care professionals about the best possible solution that safeguards the rights of the person. This is so that the safety gate is not being used as a form of restraint. Its use should be monitored and kept under frequent review. Fewer than a third of the staff have received training on safeguarding adults from abuse so they may not know how to recognise abuse and also may not know what they should do if they suspect someone has been abused. A recommendation was made at the last key inspection about training in adult protection but few staff have since undertaken this training. Sutton Oaks Care Centre DS0000069629.V363589.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): 19, 22 and 26 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Some improvements have been made to the environment but further work is needed so that people living in the home live in comfortable, hygienic surroundings. The lack of cleaning staff at the home means that levels of cleanliness are not good enough to ensure that people are not at risk infection. EVIDENCE: The new owners have carried out various improvements to the environment in the last year. These include new carpets in the ground floor corridors, the main reception area and lounge. New dining tables and chairs have been provided on both floors and new chairs and a sofa in the downstairs lounge. The ground floor has been redecorated as have individual rooms when they become vacant. The kitchen is being refurbished and a new floor provided. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 20 Few improvements have been made to the first floor. Carpets in the corridors were heavily stained and shabby. Dirty and shabby furniture was seen in a number of bedrooms. Light fittings without shades were noted in one bedroom and there was a cobweb around the central light fitting. There were other examples of poor cleanliness found but no odours were noted. The belongings of one person who had moved rooms were still in the original room despite the person having moved a week before so the person did not have access to their personal effects. We helped the social worker take this person’s belongings to the new room during the morning of our visit but they were still unpacked at 4 45pm. There were no call bells in number of bedrooms on the first floor so people living in those rooms or staff could not call for assistance. The former manager said that call bells had been ordered but these had not been fitted. One relative told us they had had to clean an en suite bathroom as otherwise it would not be cleaned. The manager said that the home was currently trying to recruit an additional cleaner. Sutton Oaks Care Centre DS0000069629.V363589.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): 27, 28, 29 and 30 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Insufficient staffing levels and a lack of training means that people are not receiving the care they need. Recruitment practices are not sufficiently thorough so that people living in the home may not be protected. EVIDENCE: The recruitment records of two staff were seen. In both cases the staff members did not start work until a full security check was received from the Criminal Records Bureau so that people living in the home were protected. Other records were available except for one reference for one staff member and their personal identification number (PIN), which is mandatory for anyone working as a nurse. The former manager thought that this information had been obtained but could not find it during our visit. Staffing levels on the day of inspection were inadequate. On several occasions a staff member could not be found for some time. This was particularly noticeable on the first floor where people in the home may not be able to use a call bell. One person was heard calling for a drink but would not have been heard as the bedroom door was closed and the room was at the end of a corridor. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 22 We also received information from other sources about inadequate staffing levels in the home. A visitor and a social worker both told us that they had been unable to find a staff member for some time when they came into the building. The staff who were available did not spend much of their time in the nursing unit of the first floor, as the demands of people living in the dementia unit were high. Staff are highly regarded by relatives and several care professionals. However, staff themselves said that they were trying very hard to manage to meet the needs of people living in the home and that this was sometimes very difficult if staff do not arrive for work or phone in sick and staffing levels are further depleted. In some instances it was apparent that care staff lacked leadership from the person in charge of the shift so that the care needed was not carried out because several staff appeared to lack initiative. It was also noted that a number of staff were wearing uniforms with the name of the previous owners written on them even though the new owners took over nearly a year ago. Information received before the inspection indicated that 17.6 of staff have achieved a NVQ2 qualification in care. However, the former manager said that a further six staff hold the equivalent qualification as they were qualified as nurses in their own country and are working in this country as care staff. It was difficult to establish what training staff had undertaken as records were poor and only partially completed. Few staff have undertaken more than a basic course in dementia. This is particularly concerning as it was discussed at the last key inspection and few staff have undergone training. Sutton Oaks is currently caring for a number of people with complex and difficult behaviour, which is presenting a serious challenge for care staff. No senior staff member has undertaken specialist dementia training and this lack of understanding of dementia is shown in the lack of person centred care, poor documentation, lack of stimulation for people with dementia and poor management of people with dementia. This means that people with dementia are not receiving the appropriate care and are being put at risk. We were told that it was difficult to release staff to undertake training because of the low staffing levels at the home. Sutton Oaks Care Centre DS0000069629.V363589.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): 31, 33, 35, 36 and 38 People who use this service experience poor outcomes in this area. We have made this judgement using available evidence including a visit to this service. There is no manager for the home currently so there is no effective leadership to ensure that the home is run in the best interests of the people living there. EVIDENCE: At the time of this visit, there was no manager in post at Sutton Oaks. The previous manager had moved to another home within the Canterbury Care group and a temporary replacement manager had also left. The previous manager returned to the home to provide the staff with support during our visit. The Operations Manager for Canterbury Care is now jointly managing the home with the former manager until a new manager is recruited. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 24 The problems identified at our visit indicate that Sutton Oaks needs a strong, effective manager to restore good standards of care in the home and improve outcomes for the people living there. Although the three requirements from the last key inspection have been met none of the ten recommendations have been implemented so that issues considered as good practice have not been put into action. The Operations Manager conducts monthly visits to the home and provides a report to the manager about the running of the home. Few of the issues raised in this report were mentioned in these reports. The former manager carried out audits of various processes in the home such as medication, care of pressure ulcers and care plans. These audits did not always highlight work that needed to be carried out to improve standards at the home. Although the manager had been sending the CSCI notifications of incidents occurring in the home as required, we were not informed about three people with moderate pressure ulcers. The manager said that ‘surgeries’ were held every other week in the evening so that relatives could meet the manager on an individual basis to discuss any issues. The manager said that there was a poor uptake of this opportunity. The manager also held meetings for anyone who wished to attend every other month but again no one had attended. One relative told us that the meetings were only held to discuss fundraising at the home. Although staff meetings have now been held to bring staff members up to date with managerial changes, several staff told us that they had not been kept informed, contributing to their levels of anxiety about the running of the home. Staff supervision records were poor and few staff had received supervision during the last six months so that they were given little support and direction about their practice and training. The sums of money held on behalf of people living in the home were checked and found to be accurate and up to date so that people know their money is kept safe until they need it. The manager gave us information about maintenance issues before our visit to the home. Several records were checked to ensure that equipment had been serviced in the last year and were found to be satisfactory. The environmental health officer has made several requirements about problems in the home and the maintenance person said these were being dealt with. Portable electrical appliances have now been checked so that people know that equipment being used in the home is safe. The maintenance person told us that fire detection systems are to be replaced as soon as practicable so that people are safe. A copy of the fire risk assessment for the home was asked for at the last inspection and has not yet Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 25 been made available to us to show that all actions have been taken to ensure fire safety in the home. Although records of fire drills and instruction were made in the fire log book, the manager could not confirm if all staff had done this training as the training chart was only partially completed. Records of moving and handling training were incomplete so it was difficult to establish if care staff had undertaken this training. Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 26 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 X 2 Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 12(1) (a) & (b) Requirement Thorough systems must be put into place to monitor people who are at risk of weight loss so further weight loss is prevented and their health is not compromised. Medication must be administered as prescribed and disposed of in a safe manner so that people receive their medication and unused medication is disposed of safely. Prescribed medication must be obtained and restocked in good time so that people receive their medicines as prescribed, without any gaps and their needs are met. Care must be provided in line with current good practice so that the privacy and dignity of people living in the home is respected at all times. All staff must undertake training in adult protection so that they DS0000069629.V363589.R01.S.doc Timescale for action 20/07/08 2 OP9 13(2) 20/07/08 3 OP9 13(2) 20/07/08 4 OP10 12(4)(a) 20/07/08 5 OP18 13(6) 20/07/08 Sutton Oaks Care Centre Version 5.2 Page 28 know how to recognise abuse and what to do if they suspect abuse has taken place. 6 OP27 18(1)(a) Sufficient numbers of cleaning staff must be employed and deployed effectively to ensure that the home is kept clean at all times and that the people living at the home are safe from the risk of infection. There must be sufficient care staff in duty at all times to meet the dependency levels of the people who live in the home so their needs can be fully met. 20/07/08 7 OP27 18(1)(a) 20/07/08 8 OP29 19(1)(a-c) Two references must be obtained 20/07/08 Schedule for all staff working in the home 2 (3 & 9) before they start work there. The PIN numbers of nurses working at the home must be checked to ensure that these are up to date. This is so that people who live at the home know that staff have been checked thoroughly to make sure they are suitable to work with vulnerable people. 17(2) Schedule 4 (6)(g) Records of all training undertaken by staff must be kept, including induction training, to show that they have received the training they need for the work they perform. 20/07/08 9 OP30 10 OP31 8(1)(a) A suitably qualified person must 20/08/08 be appointed to manage the care home so that it is well run and in the best interests of people living there. 20/07/08 11 OP38 23(4) (d & All staff must undertake suitable e) training in fire prevention and take part in fire drills. Records of this training must be kept to DS0000069629.V363589.R01.S.doc Sutton Oaks Care Centre Version 5.2 Page 29 show that staff have done this training so that all people in the home are protected in the event of a fire. 12 OP38 13(4)(c) All staff who carry out moving and handling procedures must undertake up to date training, and this must be recorded to show that they have done the training so that they and the people they are moving are safe. CSCI must be informed without delay of any notifiable event as specified under this regulation and confirm it in writing. 20/07/08 13 OP38 37 20/07/08 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 Refer to Standard OP3 Good Practice Recommendations The assessments of people’s care needs should include more detail about their mental state and cognition so that these needs can be identified and appropriate care provided. The assessment of new residents should include details about their family history, social interests, hobbies, religious and cultural needs so that these needs are identified and action taken to meet them. Care plans should be reviewed every month or sooner if necessary to reflect changing needs and amended to reflect what actions will be taken to meet those changing needs to make sure that people’s needs are met. All care staff working in the home should undertake training in person centred care so that they understand the principles of care, which is tailored to the individual DS0000069629.V363589.R01.S.doc Version 5.2 Page 30 2 OP3 3 OP7 4 OP7 Sutton Oaks Care Centre needs of the person and which values the individual. 5 OP12 The social care needs of people should be documented together with actions to be taken to meet those needs to prevent them from becoming bored and socially isolated. People’s choices in relation to their daily lives should be clearly documented on care plans so that staff are aware what people’s preferences are. Menus should be provided in large print so that people can read them. Hot food should be served at an appropriate temperature so that people can enjoy the food. The use of safety gates to protect people from other people living in the home should be reviewed frequently and regularly to make sure their use is still appropriate so that people’s human rights are not contravened. A fully functioning and accessible call system should be provided in the bedrooms of all people living in the home so that they are able to summon help when they need it. Suitable, fully functioning weighing scales should be provided to ensure that people’s weight is checked and monitored. All staff engaged in caring for people with dementia should undertake specialist training so that they know how to meet the needs of people with dementia. Care staff should receive supervision at least six times a year so that they are given support to carry out their role and have the opportunity to discuss training needs. A copy of the fire risk assessment for the home should be forwarded to the CSCI to confirm that actions have been taken to address any identified risks. 6 OP14 7 8 9 OP15 OP15 OP18 10 OP22 11 OP22 12 OP30 13 OP36 14 OP38 Sutton Oaks Care Centre DS0000069629.V363589.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston PR2 2YQ 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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