CARE HOMES FOR OLDER PEOPLE
Sycamore Lodge Residential Home Nookside Grindon Sunderland SR4 8PQ Lead Inspector
Mr Clifford Renwick Announced Inspection 10:00 14th & 16 September 2005
th 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 Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 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. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sycamore Lodge Residential Home Address Nookside Grindon Sunderland SR4 8PQ 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) 0191 525 0181 0191 528 8908 SLW Limited Judith Dolan Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (40), Physical disability (4) Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st February 2005 Brief Description of the Service: The home provides care to older people over the age of 65 years, eleven of who may have dementia or mental health needs and four places for people who may have a physical disability. It provides personal care only and any health needs are dealt with by the Community Nursing Services. The main part of the house is Victorian in construction and was previously run by the social services department. The current owner acquired the home several years ago and after extensive refurbishment reopened the home to provide care for twenty persons. Since then the owner has built an extension the home with the provision of a two-storey building, in order to enable forty people to be accommodated. All areas of the extension offer disabled access but there are some restrictions on the upper floor of the main house. The home is detached and stands in its own grounds with well-established trees and is approached by a private drive. Though it is located in the heart of the Grindon community it has a feel of being in the country due to its location and large expanse of external space. There is a large garden to the front of the home that can be used by service users and their visitors. There is easy access to a bus service, which offers services into the City Centre, where there is a range of services and shops. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 2 days totalling 8.5 hours and was carried out as part of the statutory twice-yearly inspection process. Selected areas of the premises, which included communal areas and six bedrooms, were viewed. Care records were examined as well as records that related to health and safety and staff recruitment. Discussion took place with the staff on duty throughout the visit. Discussion also took place with 8 service users and one relative and time was spent observing staff practices and how staff spoke to residents. It was established that the people who live in this home preferred to be known as residents therefore this term of reference is used throughout the report. The judgements made are based on the evidence available at the time of the inspection. What the service does well:
There is a positive commitment by the owners towards staff training and this has ensured that staff have had opportunities to develop their individual knowledge and skills. There is stability within the staff team and this has ensured that they are consistent with their work. There is also a nice atmosphere in the home and which residents stated was one of the nicest things about living in the home. This comment was also supported by a relative who stated that there is always a nice atmosphere when they visit the home and that staff are always pleasant. Observations made confirmed that staff are professional in their approach with residents whilst at the same time able to share a laugh and a joke and this contributed to the positive atmosphere. Residents stated that this is a “nice home” and “they like living here”. One resident who spent time in the home was supported by staff to move back into the community into a sheltered living environment and this is a positive are of practice for the staff. The building is well-maintained, clean, in good decorative order and residents are encouraged to arrange the furniture in their rooms to suit them. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 A range of information is available which enables residents to make a fully informed choice about where they would like to live. The admissions process ensures that resident’s needs are assessed prior to care being offered. This helps to ensure that residents are offered the right type of care at the home. Prospective residents have the opportunity to visit the home prior to making a decision to move in. EVIDENCE: A Statement of Purpose and Service User Guide are available to prospective residents and these documents inform them of the services available in the home. Discussion with the manager confirmed that the owner is in the process of having a website designed which will offer information about the home. In addition to the above documents the home also have a colour brochure, which offers a variety of views of the home both internally and externally. Examination of case files confirmed that no one is admitted to the home unless a comprehensive assessment has been completed and the manager confirms in writing that their individual needs can be met in the home. The opportunity for trial visits to the home is available and staff will use these visits to commence the assessment process as well as compiling assessment information in the prospective residents own environment.
Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 The measures staff take to support the health and personal care needs of residents is not fully recorded in the individual plan of care therefore making it difficult for staff to demonstrate how they consistently meet their needs. EVIDENCE: Each individual resident has a care plan which has been developed into a new format and layout and which are continuing to be developed. In conjunction with this document daily records, which reflect the ongoing daily care of residents, have also been developed to include more detail of day-to-day life in the home. Examination of three resident case files confirmed that nutritional assessments are in place and also a good record of how residents health needs are met by accessing all services provided by the NHS. Discussion held with staff confirmed that they were clear about individual residents needs and how they are addressing them. However this level of detail or actions taken by staff is not always reflected in the individual care plans especially when dealing with behaviours that challenge. Discussion with the manager focused upon the need to ensure that when developing the care plans only the detailed actions being carried out by staff
Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 10 should be recorded as this will ensure consistency of approach by the staff. Daily records also should include a full description when describing behaviours of individual residents and also a full account of the actions taken by staff. The terms agitated, emotional, physically abusive and challenging will then have more meaning to staff if described in full. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The meals provided offer a good balanced diet and contribute to the promotion of healthy eating and residents are involved in menu planning. EVIDENCE: A nutritional assessment, which is used in conjunction with the overall assessment process, is in use for residents, which ensures that all special dietary needs are met. Special diabetic diets are available and copies of the 3 weekly menus examined confirmed a wide range of meals is provided. A number of alternatives to the main meals are available but not fully reflected on the menu. These should be included on the menu, as this will then offer an accurate reflection of how wide the alternative choices are. Lunch was taken with the residents and this as on previous inspection visits was an enjoyable occasion. Tables are set nicely with a copy of the menus and the usual accompanying condiments and the whole process is unhurried offering residents the opportunity to chat during their meal. Discussion with the residents confirmed that the food is always very good and there is always plenty to eat. All of the residents spoken to state that they could have whatever they wanted to eat and observations made confirmed that some residents chose to pick an alternative dish to the main meal.
Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home has a satisfactory complaints system. Complaints are handled appropriately and the outcomes used to improve the service. Robust procedures are also in place, which ensure that service users are protected from abuse. EVIDENCE: A copy of the homes complaints procedure is on display in the main lobby and all residents have been issued with a copy of the procedure. There were no recorded complaints but the manager recently used the standard local authority review system to address some concerns raised by a family of a resident. Policies and procedures are in place, which deals with the protection of vulnerable adults, and some recent revision has been made to these documents. Discussion took place with the manager about the need for some minor amendment to the documents and this will be discussed further in a meeting separate from this inspection where advice will be offered. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The home is clean, warm and well maintained offering service users a homely and safe environment in which to live. EVIDENCE: A representative number of bedrooms and all communal areas were viewed and this confirmed that the home was in good decorative order with no noticeable hazards. Ongoing and regular maintenance of the home ensures that any matter relating to the premises is addressed immediately so that at no time is resident’s safety compromised. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Staffing levels are sufficient to effectively meet the needs of resident’s living in the home. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. All staff receive ongoing training to ensure that they are competent in all areas of their work. EVIDENCE: Examination of staffing rotas confirmed that the home continue to maintain previously agreed staffing levels. At the time of the inspection there were three workers undergoing “Springboard” training and these people were allocated to work with experienced members of staff. Examination of staffing files for three new persons employed in the home confirmed that not all of the necessary documentation as required by regulation was available for examination in respect of their employment. Training is ongoing within the home and two of the senior staff are undergoing training in NVQ Level 4 and also the registered managers award. A key worker system has been developed for staff and this has resulted in the introduction of extra responsibilities for staff in dealing with areas of resident’s personal care. A system of monitoring this has been developed and this is used to focus on key areas of staff work, which ensures that all aspects of care for the residents are addressed. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 The manager offers clear leadership and direction to the staff so that they can consistently meet the needs of residents. Residents are asked by the organisation and by staff about how they want their support to be provided so that their rights and best interests are promoted. A well-managed staff team promotes the health and safety of the residents. EVIDENCE: Since the last inspection the commission has registered the manager. The manager has ensured that staff supervisions are carried out and these are also linked to an annual staff appraisal. It was noticeable that the manager has implemented a number of positive changes within the home that will have benefits for the residents. The manager has recently completed an annual quality assurance audit with relatives and to date 15 questionnaires have been returned. The manager
Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 16 confirmed that she intends to use the views expressed in the survey to develop the service. The home achieved the Investors in People Award in March of this year. Examination of the fire logbook confirmed that all staff receive satisfactory fire instruction and take part in regular fire drills. Fire risk assessments are in place and are checked weekly. A recent visit by the fire officer indicated that these were satisfactory but some further development is required in relation to the kitchen and the equipment in use. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 17 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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 18 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 2 3 Standard OP7 OP15 OP29 Regulation 15 17 (2) Schedule 4 7, 9, 19 Requirement Residents care plans must be developed as advised during the inspection. A record of all alternative meals provided must be made available. Records must be kept in respect of persons working in the home as specified in Schedule 2 of the Care HOMES Regulations 2001. Immediate (outstanding since 21/02/05). Timescale for action 30/05/06 31/12/05 16/09/05 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 OP38 Good Practice Recommendations Fire risk assessments in relation to the kitchen area and equipment in use should be developed following the advice offered by the fire officer. Sycamore Lodge Residential Home DS0000015741.V249923.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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