Inspection on 22/08/08 for Sutton Village Care Home

This inspection was carried out on 22nd August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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Snydale Care Home

Hawkhills

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Sutton Village Care Home 30 Church Street Sutton Hull East Yorkshire HU7 4TA Lead Inspector Beverly Hill Key Unannounced Inspection 22nd August 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sutton Village Care Home DS0000071540.V370619.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 Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sutton Village Care Home Address 30 Church Street Sutton Hull East Yorkshire HU7 4TA 01482 707085 01482 712668 suttoncarehome@suttoncarehome@karoo.co.uk 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 Mark McWilliam Mrs Susan Crum Care Home 23 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (23) of places Sutton Village Care Home DS0000071540.V370619.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 only - Code PC; to service users 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; Dementia - Code DE. The maximum number of service users who can be accommodated is: 23. New Service 2. Date of last inspection Brief Description of the Service: Sutton Village Care Home is a large detached house standing in its own grounds. The village of Sutton, in which the home is situated, has local facilities including shops, a post office and churches. There is easy access to local public bus services. The home is registered to provide care and support to twenty-three older people, some of whom may have needs associated with dementia. Accommodation is on two floors serviced by a through floor lift and consists of three shared and seventeen single bedrooms, three of which are en-suite. The home has a large lounge with a dining table at one end for activities and a separate dining room set out with individual tables. There is a further small seating area for two to three chairs in the dining room. The home has one recently refurbished assisted bathroom on the ground floor and two bathrooms, one of which is assisted, and a shower room on the first floor. There are sufficient toilets to meet the needs of people close by to bedrooms and communal areas. The gardens are secluded, well maintained and provide seating for residents. There is a private car park, which provides ample parking space. The current scale of charge is between £348.50 and £398.50 per week. This latter figure includes the maximum top up, which could be between £20 and £50 depending on the bedroom. Additional charges include hairdressing, chiropody, toiletries, newspapers/magazines and taxis for personal use. Information about the home is included in the statement of purpose and service user guide, which are located in the home and distributed to potential residents. Sutton Village Care Home DS0000071540.V370619.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 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the registration of the home by new owners on 26th February 2008, including information gathered during a site visit to the home, which took approximately nine hours. The new owner Mr Mark McWilliam is part of a family, which owns and manages several homes in the area. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Sutton Village Care Home and what the change of new ownership had meant for them. We also had discussions with the proprietor, the registered manager, and care staff members. Information was also obtained from surveys received from nine people that live at the home, two relatives, eight staff members and two other visitors. Comments from the surveys have been used throughout the report. We looked at the information provided to prospective residents or their representatives to check that people had full information on which to base a decision about the home. We also 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 checked how staff monitored the food and fluid intake of those with nutritional risks. 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. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The AQAA was very comprehensive but it needed to remove details about individual residents. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 6 We would like to thank the people that live in Sutton Village Care Home, the staff team and management for their hospitality during the visit and also thank the people who completed surveys and had discussions with us on the day. What the service does well: The home continues to provide a pleasant environment for people to live and work in. It had a friendly and homely feel, and was clean and fresh. People had assessments of their needs prior to admission and could have trial visits. This made sure that the home were fully aware of how to support someone before they were admitted and gave people the opportunity to look around and sample the home before making the important decision to stay permanently. The manager had an open-door policy and encouraged people to speak to her if there were any problems. Also visitors were welcomed at any time of the day, which was confirmed in discussions with people that live in the home, a relative and staff members. This created an environment where people felt able to complain. Any complaints were looked at straight away and sorted out. Staff members supported people in ways that respected privacy and dignity. They showed good understanding of how to make sure people could make choices about their lives even if these were only limited because of their condition. People spoken with and surveys received from them were happy with the care received. The home provided activities for people to participate in and ensured that they took advantage of local shops and facilities. People who lived at the home stated they liked the meals and drinks provided. There were choices on the menus and people stated they could have alternatives if they didn’t like what was on offer for the main meal. The percentage of staff trained to national vocational qualification (NVQ) level 2 and 3 in care is 75 . This is a very good achievement and exceeds the standard. However there was still some work to do to make sure people had refresher training in mandatory topics. See below. The home had been awarded parts 1 and part 2 of the Local Authority Quality Development Scheme for ensuring care plans and a quality monitoring system was in place. The home continues to be well managed and looks after peoples’ finances appropriately. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The home has developed a new statement of purpose and service user guide/information pack. Both documents need attention to make sure people have full information about the home to help them decide if it is right for them. We also noticed that one person who was self-funding their care only had a financial contract and not the full terms and conditions contract. People need to know what to expect from the service and the full contract explains this. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 8 Care plans must really include all assessed needs and be evaluated and audited properly so that changes can be identified and shortfalls addressed. This will ensure that care staff have full information about people and prevent care from being missed. Also when assessing people’s risk regarding nutrition and skin condition the home could use recognised tools or be more comprehensive with their own risk assessments. This will more easily alert staff to any risks so they can plan to minimise them. The manager needs to make sure that staff members follow policies and procedures when administering medication to people. This will enable them to be confident people actually take their medication before completing the medication administration record. Some staff should also improve the way they record daily care and sign the reports. This will make sure all care is recorded and be clear about who has written the report. Now that staff training needs have been identified the home must make sure that they are met. This will ensure the staff members have up to date skills and knowledge to care for people with specific needs. The home has routinely employed people before the return of the criminal record bureau check, although always after a check of the protection of vulnerable adults register. This system should only be used in exceptional circumstances and not routinely. 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 Village Care Home DS0000071540.V370619.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 Village Care Home DS0000071540.V370619.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, 2, 3, 4 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. Some adjustments are required to the information provided to potential users of the service to enable them to have full information prior to admission. People continued to have assessments of need completed prior to admission and the home obtained copies of assessments completed by care management. This enabled the home to have full information about the person in order to decide whether they can meet needs. Some staff members lack particular up-to-date skills, which mean people cannot be confident their needs will be met in the home. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home provided information to prospective residents and their relatives via a statement or purpose and a residents’ information pack. Some adjustment to the statement of purpose is required to ensure it contains full information regarding the qualifications and experience of the registered provider. This is especially important as the document states the proprietor may visit and complete assessments of need prior to admission. There also needs to be more information regarding the range of needs the home is able to meet. The ‘criteria for admission’ section contains information about the homes response to emergency admissions. This section states an assessment is completed during the first week of an emergency admission stay, however the assessment must be completed prior to admission even in cases of emergencies as the home may not be able to meet the persons’ needs and this could result in them moving to another home. This needs to be clearly stated to give people the correct information. The service user guide/residents’ information pack provided to prospective residents has some good information but also needs some adjustments so it contains the full range of information people need. The description of the premises includes the exterior of the property but does not detail individual accommodation and communal space provided. It contains the experience and qualifications of the manager and staff but not the proprietor and it does not include any details of what existing residents think about the home. The manager confirmed that all residents have been issued with a new terms and conditions document since the new proprietor purchased the home. We examined documentation for a person who self-funded their placement at the home and the terms and conditions section was not there. The person had a financial contract only, a section of which had been signed in error. We examined three care files during the visit, one of which was for a new admission to the home. There was evidence the home obtained assessments and care plans completed by care management and the manager visited people at home or in hospital to complete the homes in-house assessment. The homes statement of purpose also states that the proprietors may visit potential residents to complete the assessment process. The information gathered enabled the home to decide whether they were able to meet the persons’ needs within the home. Examination of assessment documentation indicated all needs were identified and the date of completion was prior to admission. The home formally wrote to people or their representative following admission stating the homes ability to meet their needs. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 12 The manager stated the home provided a respite care service and this gave people the opportunity to try the home and get to know staff and the homes way of working during regular visits before making any final decision about permanent residency. We spoke to one person receiving respite care and they confirmed this. There was evidence that people visited the home prior to admission and comments in surveys regarding this were, ‘staff welcomed me and showed me around twice and provided me with comprehensive literature’, ‘I had a look around and was told how the home worked’ and ‘I received all the information I wanted to know’. People were encouraged to visit the home and look around and the home provided them with information about services. The first four to six weeks of any admission were seen as a trial period then a review was held to discuss the stay and whether permanent residency was required. The home provides information about staff experience and training in the service user guide information pack. The information details that updates in training are required and in some cases staff have not completed mandatory training. People cannot be assured that staff can meet their needs if they lack up to date skills in particular areas. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 13 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, 10 and 11 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. Gaps in recording of care plans, some risk assessments and daily monitoring mean that staff may not have the full information required to support people and care could be missed. People received care and support in ways that promoted their privacy and dignity. The administration of medication witnessed on the day for one resident was not sufficiently robust to ensure health and wellbeing. EVIDENCE: We examined three care files and they contained various assessments and risk assessments in order for staff to use to formulate plans of care. Decisions had been recorded about care after death and the deputy manager confirmed Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 14 people could remain at the home for the remainder of their lives should they choose to, and medical needs allowed. There had been no change in the format of care planning since the last visit although the deputy manager stated new care plans were to be introduced to bring the home in line with other homes in the group. Currently the care plans are computerised and the manager or deputy updates them on the computer when needs change. Care plans referred to maintaining privacy, choice and independence. In discussions staff were clear about how to promote independence and provide care that respected privacy and dignity. Residents and their relatives also said that care was provided in ways that respected privacy and dignity. Those care plans examined lacked some details to ensure that staff had full information about peoples needs and knew how to meet them. For example one person had needs identified in the local authority assessment associated with short-term memory loss, anxiety and constipation but these had not been transferred to the homes plan. One person had epilepsy but there was no plan for staff to monitor or manage any seizures. According to staff the person was having, ‘absences’ rather than full seizures but this information would need to be on the care plan with a clear actions for staff. Monitoring needs to be in place should professionals request information on patterns and frequencies of them. Similarly two people had risk assessments highlighting behaviours that could be challenging but again there was no clear guidance plan for staff detailing the consistent approach they should use to manage the behaviours. One person had lots of falls recorded and this was mentioned in a generic risk assessment with a statement suggesting the person was referred to the falls team for assessment. However there was no mention in the care plan of how staff members were to minimise the risk of falls or to monitor them. One of the care plans had been signed by the resident as agreed, but on closer examination some error had been made at the printing stage and their care plan consisted of one half belonging to another resident. This suggested that staff had not gone through the care plan with the person thoroughly or the mistake would have been noticed. One person also self-medicated a part of their medication. Although this was good practice in ensuring the person maintained a level of independence they required a risk assessment and care plan for this to ensure staff monitored the process. There was evidence of monthly care plan evaluations, although these lacked a professional system of recording. On one occasion noted a change in need identified in the evaluation was highlighted in a risk assessment but not inputted into the care plan. This means that staff might not be aware of the changes. Reviews of care plans were carried out with the resident, their family Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 15 where possible, and care management when funded by them. There was evidence that people who self-funded their placement also had six monthly reviews. Staff members recorded daily care but some staff were more comprehensive with their reports than others. For example one person was often recorded as, ‘self manages personal care’. However it was clear the person often declined support from staff and it needs to be clear what approaches were tried to encourage personal care and what measures were taken when the person declined. Staff did not consistently sign the daily reports. There was also limited key worker recording. The entries recorded for key working tended to be chats during personal care tasks rather than specific one to one time with the person. There was evidence that people had access to health care professionals. People spoken with stated their health needs were met and surveys stated the staff team called the doctor when required, ‘the manager and staff identifies potential problems in the early stages and takes appropriate action to prevent development’, ‘medical staff are called as required to treat and monitor health care needs’ and ‘I had a problem and Sue (manager) sorted it out’. Some areas of risk were identified and planned for. However the home did not appear to use any specific nutritional risk assessment and pressure sore risk tool in the files examined. The dietician and district nurse would be able to advise on the most appropriate tools for the home and residents. Medication was stored appropriately and signed in on receipt into the home. Since the last visit the home had obtained a new medication trolley. This was clean and tidy. During the visit we witnessed medication in a pot left on the table for a resident to take. This would have been appropriate had the staff member stayed to witness the person take their medication. However the medication was signed for and the staff member left the room. This placed other residents in a potentially vulnerable situation. The resident finished their meal and, although they managed eventually, they had some difficulty manipulating the tablet out of the container. Staff did not follow policies and procedures and witness the person taking their medication prior to signing the medication administration record. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 16 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 home continued to have flexible routines and promoted choice and individual decision-making. The home provided well-balanced meals, which met peoples’ nutritional needs. EVIDENCE: People spoken with stated that routines were relaxed, visitors were welcomed and people made decisions about aspects of their lives. Comments about the home were, ‘you can get up and go to bed whenever, I choose to go to my room after the meal at night’, ‘visitors come anytime’, ‘I visit almost every day, I know what goes on and I’m happy with the care’, ‘they (visitors) always get offered a cup of tea’ and ‘its very homely and friendly and everybody is welcome’. Some people chose to have their meals in their bedrooms and spend part of the day there, enjoying their own company and solitary activities. Others chose to join in the activities provided by the home. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 17 These included fortnightly visits from an occupational therapist so people can participate in reminiscence therapy, movement to music, quizzes, 1-1 and group sessions. The home also designated one carer to provide activities for two and a half hours a day during the week. People spoken with described activities such as games, cards, beetle drives, dominoes, bingo, manicures, visiting entertainers and craftwork. They also told us they were due to visit a local park later in the week and some people described outings with their families. Two people still go out to the local church each week and a further two people attend an external social club on a weekly basis. One person told us they used to play the piano and was slowly getting back into it. Another resident told us they liked to be part of organising activities and was involved with a raffle last week. The home purchased local newspapers and some residents liked to purchase their own. Local clergy visit the home for services and the library has a book exchange system in the home. One of the people exchanging books on the day of the visit was overheard wondering how residents could reach the books on the shelves provided. They were a little out of reach and the manager should discuss with residents where they feel the most appropriate and accessible place would be for them. Staff confirmed the home had monthly entertainers and organised trips out. Shops and facilities are so local that occasionally they can support people to use these. People spoken with enjoyed the meals provided by the home and comments from them and surveys were, ‘the foods good you get plenty to eat and drink’, ‘the food is traditional – very good’, ‘I look forward to meals’, ‘good choices’, ‘now we have choice the meals are good and ‘she enjoys the food in the main and has gained a great deal of weight’. Since the last inspection the choices available have increased. We observed a mealtime and the meal on offer was fried fish, chips and mushy peas with strawberry cheesecake for desert. It was very well presented and cooked and there was a range of drinks available. Staff members checked with people if they had enjoyed their lunch or if they required any more. One person was seen to ask for an alternative desert and her request was arranged. The mealtime was a social event and specific people grouped at tables chatted to each other over their meal. Staff members were available to assist. Serviettes had not been provided routinely although when requested by one person they were provided. The cook provided home baking, and cakes and pastries were presented very well. The menus rotated over a four-week period and they indicated a hot and cold choice at teatime. Special diets were catered for and since the last visit the cook received written information after the assessment regarding peoples’ Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 18 needs, likes and dislikes. The home had scored very well in a visit by environmental health officers. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 19 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, 17 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 continues to provide an environment where people feel able to complain, are safeguarded from abuse and can exercise their citizenship rights. EVIDENCE: The home had a complaints policy and procedure that was displayed in the lounge. Since the last inspection this had been more prominently sited. The policy stated timescales for resolution of the complaint and there were complaint forms for people to fill in and give to staff members or the manager. Since the last inspection the home had received three complaints, as detailed in the AQAA document and in records examined during the visit. These were minor in nature and had been dealt with appropriately. There was evidence from the complaints file that people had made suggestions, had been listened to and their suggestions acted on. The complaints procedure could include details of how people can contact the local authority with any complaint should they wish, for people funded by them. People spoken with stated they felt able to complain, ‘I would tell the manager, I haven’t any to date’, ‘I don’t have any complaints’, ‘you can make suggestions and they listen to you’, ‘I would see Sue – she would soon sort it Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 20 out’ and ‘I would go to the office’. All nine surveys from residents stated they knew how to make a complaint and who to speak to if they were unhappy about something. Staff in surveys also stated they were aware of the action to take if a resident or their relative wanted to make a complaint. The manager confirmed that residents are registered to vote. Some residents choose to use the postal system or choose to opt out. The home supports two residents to visit local polling stations to vote and another chooses to be supported by a relative. The home had information about advocacy services on display, and other important information was included in the statement of purpose. Most staff members had completed training in the safeguarding of vulnerable adults from abuse. The home had policies and procedures in place and staff members spoken with were fully aware of what to do if they suspected abuse had occurred. The manager and deputy manager were aware of the multiagency referral and investigating procedures with the local authority as lead agency for investigation of any suspected abuse. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 21 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, 21, 22, 23, 24, 25 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 continued to provide a clean, safe and comfortable environment for people that lived there. People had the opportunity to personalise their bedrooms, which made it homely for them. EVIDENCE: The new owners are in the process of upgrading the building with redecoration and re-carpeting certain areas. The exterior of the building has been painted. The home employs a maintenance person and minor repairs are dealt with straight away. The home has large sections of old wood panelling on the walls and a residents/relatives meeting highlighted a preference by people that this be retained. The new owners have respected this. The proprietor advised that the target for completion of redecoration was the end of December this year. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 22 The home has a large lounge with a dining table at one end for activities and a separate dining room set out with individual tables. There is a further small seating area for two to three chairs in the dining room overlooking the garden. The proprietor advised that the hallway was in the process of redecoration and the lounge and dining room were next. The lounge was also to have an area at the back for staff to keep secure care plan documentation and to write up their notes. This will mean staff can remain with residents whilst completing this task rather than away in the office. People have access to a well-maintained garden, which has seating for residents and is quite secluded. The garden and the main entrance to the home are accessible by ramps. Although there are no residents wishing to smoke at present, the garden area would be used for this. There is also a private car park within the ground. Corridors in the home are wide to accommodate wheelchairs and handrails are in place throughout to assist people with mobility difficulties. The home has a selection of moving and handling equipment sufficient to meet peoples’ current needs. The home has one recently refurbished assisted bathroom on the ground floor and two bathrooms, one of which is assisted, and a shower room on the first floor. There are sufficient toilets to meet the needs of people close by to bedrooms and communal areas. Bathrooms and toilets had appropriate hand wash soap and paper towels in place. Hot water outlets used by residents had thermostatic control gauges fitted to prevent scalding from very hot water. One of the toilets on the ground floor needed attention regarding a loose seat. This was mentioned to the deputy manager to address and the toilet door was locked to prevent anyone using it until it was repaired. Accommodation was on two floors serviced by a through floor lift and consisted of three shared and seventeen single bedrooms, three of which were en-suite. One of these en-suites was a full bathroom with a bath suitable for more able people. People were encouraged to bring in personal items with which to make their bedrooms more homely and this was seen to varying degrees. The bedrooms were of a good size and the high ceilings in most gave a feeling of space. Since the new owners took over five bedrooms have been completely redecorated and fitted with new carpets and lighting. People spoken with were happy with their bedrooms and the home in general, ‘I really like the home – I wouldn’t change anything, ‘my room is cleaned daily and yes its always fresh’, ‘its very homely and friendly’ and one person said that if you had to have residential care then this was a, ‘good place to be’. The home has a separate laundry room with an open system sluice. It has one commercial and two domestic washing machines and one large drier. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 23 The home also has a main office in the entrance for use by the manager, deputy manager and administration officer. The proprietor stated they have plans to open the office up and make it into a reception area. There is also a staff room for staff. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 24 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Gaps in mandatory training and updates and some service specific areas mean that staff members may not have the required skills to meet people’s diverse needs. However support was provided by caring staff in sufficient numbers. The homes recruitment processes were not consistently robust to safeguard vulnerable people. EVIDENCE: Staff rotas were examined and showed there was generally three care staff members on duty during the day, plus the manager or deputy manager and two staff at night. The homes AQAA states that usually the home provided 364 care hours per week and when hours were calculated using the residential care staffing forum based on dependency levels of people living in the home, this was sufficient to meet the current needs of residents. Out of eight staff surveys, seven stated they had enough staff, ‘always’, whilst one person stated this was, ‘usually’. Staff spoken with and surveys received from them showed that they enjoyed their work and felt there was a happy and friendly atmosphere in the home, ‘we get on with each other’, I love Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 25 working here’, ‘the morale is good’ and ‘we do the job to the best of our abilities – as long as the residents are ok I’m happy’. The home had a training plan and there was evidence that mandatory and service specific training was covered in this. Each staff member had a personal training plan that recorded the training participated in and a rolling programme was organised. However progress appears to be slow. When figures were examined there were quite a few staff that had not completed mandatory training, for example eleven staff needed fire training with the rest needing updates, ten staff required first aid, two of which were updates, and seven care staff required moving and handling training with the remaining care staff requiring refresher training. Eleven staff members were still to complete infection control. There has only been minimal change in the numbers of staff completing mandatory training since the last inspection. However three staff completed a two-day dementia care awareness course, ten completed continence management and bereavement awareness and three seniors completed medication training. The manager and deputy manager completed equality and diversity awareness with the local authority and a half-day seminar on using skills for care common induction standards for new staff. There was still some work to do to ensure staff had up to date skills required to meet the needs of people living in the home. Training consisted of external facilitators, distance learning and courses provided by the local authority. Induction met skills for care standards and competence was assessed and signed off by senior staff. Despite the gaps in mandatory training the home had exceeded the requirements for national vocational training in care. According to information received from the manager the home had twelve care staff that had completed NVQ (national vocational qualification) level 2 and 3 and a further two progressing through the courses. This equated to 75 of care staff trained to this level and indicated the home was committed to ensuring staff completed this specific training. People spoken with and surveys received were complimentary about the care staff team. Comments were, ‘I see the same staff and they provide continuity of care. They treat mum with dignity and respect’, ‘staff are always available to listen and care’, ‘they score well in terms of listening’, ‘everyone is helpful’, ‘staff are very good’, ‘excellent’, ‘the staff care remarkably well’, ‘they are friendly, look after us and do little extras’ and ‘you ask for something and its there’. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 26 We observed staff talking to people in a friendly and courteous way, they were supportive at mealtimes and had time to sit and chat to people. The atmosphere continues to be relaxed. Generally the home operated a robust recruitment process. References and criminal record bureau checks (CRB) were obtained and checks made against the protection of vulnerable adults register (povafirst). Care staff members were selected via an interview process. We looked at four recently employed staff files. Two staff had been employed after a povafirst check but prior to the return of the full CRB. This must only be in exceptional circumstances and not be as a matter of routine. When this does occur stringent supervision arrangements must be in place. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 27 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, 32, 33, 34, 35, 36, 37 and 38 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. Generally the home continued to be managed well with residents welfare and safety promoted and protected. Some gaps in the auditing of documentation such as care plans could be improved to ensure up to date information and to prevent care being missed. EVIDENCE: The registered manager has worked as a manager for eight years and has completed the Registered Managers Award. She gained a certificate to enable her to train staff in moving and handling. However the initial training was in Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 28 2001 and this may need refreshing to remain valid. She has completed mandatory training courses in other areas such as, first aid, fire safety, medication, safeguarding adults from abuse, health and safety, basic food hygiene and infection control. She has also attended seminars on skills for care induction, standardising NVQ assessment, and with the Commission during the introduction of the AQAA (annual quality assurance assessment). This shows us the manager is committed to improving her knowledge and skills and keeping up to date with changes that affect the service. Staff spoken with felt supported by the manager and surveys commented on her supportive and approachable manner, ‘she’s great – approachable’, ‘she works weekends as shift patterns have changed so she’s available’, ‘you can ring her’ and ‘you can go to her with anything’. Residents and their relatives also knew the managers name and stated they would speak to her if needed. This told us the manager was accessible to people and approachable. There was evidence of regular meetings with residents and relatives and the proprietor told us that during discussions with them they had requested the old wood panelling in the home to remain during any refurbishment, which had been agreed. This told us the proprietor listened to the views of people living in the home. The home had a quality assurance system that consisted of audits and questionnaires to people and their relatives. The home has also produced a questionnaire to send to visiting professionals to obtain their views. The manager had produced a quality assurance assessment report regarding the service they provide and how this is evidenced. It was clear that a lot of work had gone into the document as had also gone into the homes completion of the AQAA (annual quality assurance assessment) requested by the Commission. Both documents state that the home sends out surveys to residents, relatives, staff and visiting professionals at intervals during the year. The AQAA states that results of questionnaires are published in the home. Although the AQAA was very comprehensive it needed to remove details about individual residents. Gaps in the auditing of care plans was apparent as some did not contain full, and in one instance correct, information. The home had been awarded parts 1 and 2 of the local authority’s quality development scheme. The home had up to date policies and procedures available to guide staff and information was securely maintained. The money deposited for safekeeping at the home was well managed with individual records maintained. Receipts were obtained when staff members assisted people to purchase items from local shops and on outings. The home did not manage any persons’ finances for them, as relatives fulfilled this role. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 29 One person was supported to visit their local bank by staff and had requested their bankcard and details be held by the home for safekeeping. There was evidence from discussions and documentation that staff members were supported by the provision of regular supervision. The manager had a supervision plan and topics covered were training needs, progress, any issues arising with the people the staff member supported and their key working role. Supervision was up to date and staff had annual appraisals. The new provider was spending quite a lot of time in the home and there was a support network available for the manager and staff with other homes in the group. Health and safety was managed well and equipment used in the home was serviced and maintained appropriately. Fire equipment was maintained and staff received regular training, and alarm tests were completed. Since the last visit the manager had increased the frequency of fire drills to ensure staff were fully aware of the procedure and had a chance to practice their response. Records were maintained of all fire safety checks. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 30 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 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 3 3 Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 18 Requirement The registered person must ensure that staff, individually and collectively, have up-to-date skills and experience to deliver the services and care which the home offers to provide. This is so people can be confident that their needs are recognised and met. The registered person must ensure that all assessed needs have plans of care in place and provide staff with full guidance on the tasks they must perform to meet them. This will ensure that care will not be missed (previous timescale of 30/09/07 not met) The registered person must ensure that adequate arrangements are put in place for the administration of medicines. This helps to ensure that medicines are given correctly in order to protect people’s health and wellbeing. The registered person must ensure that staff are routinely DS0000071540.V370619.R01.S.doc Timescale for action 31/12/08 2 OP7 15 30/11/08 3 OP9 13(2) 22/09/08 4 OP29 19 22/09/08 Sutton Village Care Home Version 5.2 Page 32 5 OP30 18 employed only after a satisfactory criminal record bureau check and not as a matter of course after a povafirst check and prior to the return of the CRB. This will assist in the safeguarding of vulnerable adults that live in the home. The registered person must 31/12/08 ensure that staff members have up to date skills so they can fulfil the aims of the home and meet the changing needs of the people using the service. 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 OP1 Good Practice Recommendations The manager should ensure that the homes statement of purpose and service user guide contains the full range of information people need to make an informed decision about the home. This information is located in the national minimum standards and care homes regulations. The registered person should ensure that people have terms and conditions in place regarding the care they are to receive. This also applies to people who self-fund their care. This will ensure people are fully aware of their rights and responsibilities regarding the services provided in the home. The manager should ensure that staff consistently sign the daily recordings of the care provided to people and that these contain full information about the persons care received during the day and night. The manager should review the way care plan evaluations are recorded to demonstrate a more professional approach. The provider should refine the generic tool used to assess risk and include more individual risk assessment for nutrition and pressure areas. Alternatively specific professional tools for nutrition and pressure area risk can DS0000071540.V370619.R01.S.doc Version 5.2 Page 33 2 OP2 3 OP7 4 5 OP7 OP8 Sutton Village Care Home 6 OP16 7 8 OP30 OP33 be used. The provider should include information in the complaints procedure about how people can complain to the local authority, if funded by them, regarding any concerns they have about the care they receive. The homes training plan should include conditions affecting older people and dementia care training should be rolled out to all care staff. The manager should improve the system of auditing care plans to ensure they contain full and accurate information. Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sutton Village Care Home DS0000071540.V370619.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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