CARE HOMES FOR OLDER PEOPLE
Sycamore Lodge Residential Home Nookside Grindon Sunderland SR4 8PQ Lead Inspector
Mrs Katie Tucker Key Unannounced Inspection 8:40 9 and 10th August 2006
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.V304187.R02.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. Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 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.V304187.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13th February 2006 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 fees charged at the home range from £359 to £374 per week. The main part of the house is Victorian in construction and was previously owned 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 to 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.V304187.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 2 days. One inspector spent 10 hours at the home speaking to people using the service, staff and visiting relatives. Prior to the visits the inspector also spoke to other professional that visit the Sycamore Lodge. Several residents were identified. The care they received was tracked through discussions with all concerned and by looking at the service user plans. Sycamore Lodge provides a service for older people and people with a dementia-type illness. Some of the people experienced difficulty communicating their views verbally. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. All of the available information was used to make decisions about the quality of service. During this inspection all of the key standards were checked. What the service does well:
Staff were very attentive towards the residents. The staff encouraged residents to actively make decisions about the care they received. Residents said ‘the girls are lovely’ and ‘it is a pleasure to be here, the girls are really good’. Staff obviously valued the people using the service and as far as possible respected their wishes. Staff looked at the needs of residents and how these could be met, often working to help people maximise their mobility and independence. Staff use lot of light-hearted banter and residents obviously thoroughly enjoyed this approach. Residents said ‘the girls are dead canny and down to earth’. Throughout the visits a number of more able residents choose to assist other residents. Staff promoted and supported residents to continue this caring role. This positive staff practice led to a real sense of community and residents looking out for one another. SLW Limited expects staff to be competent and skilled. Therefore they arrange access to a wide range of training for all of the staff. All of the domestic staff have achieved NVQ awards, as well as the cook and 87 of the care staff have achieved an NVQ level 2 award. Plus staff are completing level 3 awards and 3 staff have recently successfully gained the level 4 award in care. Recently 3 staff members completed the assessor’s award and can no assess NVQ work. The owners also provide access to training not only around mandatory training but courses to improve staff knowledge about specific care needs such as nutrition.
Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 Page 6 SLW Limited makes sure the home is decorated and furnished to a high standard. Plus the domestic staff take a genuine pride in keeping the home clean and residents said ‘the home is always nipping clean and smells lovely’. 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.V304187.R02.S.doc Version 5.2 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.V304187.R02.S.doc Version 5.2 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): 3 and 6 The assessment information is improving but contains insufficient information to demonstrate that the home can care for the person. Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Case tracking showed that the information contained in the assessment was limited. It consisted of the information the social worker provided and a series of care plans, which covered mainly daily living skills. Staff have not recorded information about people’s social, cultural, spiritual and emotional needs. Staff had not recorded whether a particular physical condition actually affected the person or limited their ability. Often these care plans contained minimal information and had not been up dated as people’s needs changed. This led to difficulties in identifying the areas of need that were most pressing. The home cares for people with a dementia and although staff were recognising the importance of people’s life histories this information was not used very well in the assessment. Finally when residents have mental health needs and be subject to detention orders staff are not clarifying exactly why this occurred and therefore do not know what this means for the home or resident.
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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, 9 and 10 Although staff care practices are very good. The service user plans do not reflect the care that is offered at Sycamore Lodge. Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Case tracking showed that the flaws in the assessment document have led to staff not completing care plans around people’s greatest needs. When writing care plans, staff do include the full amount of information needed to show how to meet someone’s needs. Also staff tend to concentrate on physical healthcare needs when often residents’ main needs relate to social or emotional needs. In practice staff were meeting resident’s needs and were very aware of the best way to work with people but this was not recorded. Therefore their good practice was not evidenced. Currently residents or relatives do not record that they have been consulted about the proposed care and agreed to the plan. Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 Page 10 Although risk assessments are being generically used, assessments for showing that the risks people take have been judged to be acceptable need to be more widely used. Also risk management strategies must be applied more widely. These types of plans show the strengths people have and the common day risks they can continue to safely take. Staff impose limitations on some residents because of their dementia or physical health needs such as needing to be accompanied when outside the home. When limitations are imposed for a particular individual this needs to be recorded. When residents have to follow Sycamore Lodge’s house rules can be recorded in a standard contract. Discussion was also held around how to change staff practice so on admission resident’s were encouraged to be as independent as possible. Thus because resident’s were actively told what they could do they would be confident about continuing to make their own drinks, go out on their own and organise their day. On the whole the medication system has proved to be effective. However, on occasions when weekly medication is received staff are forgetting to record the amount and date on appropriate sheet. This practice creates difficulties in completing an audit trail, monitoring the use of medication and recording returning medication. Staff and residents had formed good working relationships and this assisted and contributed to the pleasant atmosphere that was present. During this visit staff had made sure that everybody’s personal care needs were met. Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 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): 12, 13, 14 and 15 Staff provide support to residents and assist them to led fulfilling lifestyles. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Staff are responsible for organising activities and throughout the visits they endeavoured to keep residents occupied. This appeared to be more successful in the units for dementia care and residents on the other units said ‘it tends to get a bit repetitive as all we are asked to do is bingo’. Residents did talk about the entertainers that visit and the trips out. One resident said that they regularly went out by themselves into to town and to the local shops. It was suggested to the manager that as part of the assessment they asked residents what they liked to do and then this information could be used when designing an activity programme. Visitors and residents said ‘the staff were excellent and were always friendly’. People said they were kept abreast of changes in their loved ones healthcare. Residents had formed good relationships with one another and there was a real sense of community within the home. Staff promoted and support residents to take an interest in each other and people really cared for one another. The food was of a high quality and plentiful.
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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 and 18 The owner proactively deals with complaints and concerns. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The complaints procedure is made available to residents and relatives through the service user guide. Residents said ‘the staff listen to what you say and if your worried about something or something is not right will sort it out’. They felt the owner was open and willing to listen to concerns people may have. Case tracking showed that when people had raised concerns, even minor irritations the owner treated these seriously and took action to resolve the issue. Staff did not dismiss people’s opinions and this was evident in how they worked with people to negotiate the care that would be provided at Sycamore Lodge. Sycamore Lodge has an appropriate protection of vulnerable adults policy and follow Sunderland Social Services Department guidance. Staff are fully aware of how to use the procedures and the manager has recently updated the home’s policy. This policy is clearly written. Staff receive regular training and up dates. Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 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 and 26 The home is clean, warm and well maintained offering residents a homely and safe environment in which to live. Quality in this outcome area is excellent. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: SLW Limited have a very comprehensive maintenance programme and throughout the year up grade and redecorate the home. Thus year on year new furnishings are purchased, the latest equipment bought and rooms redecorated. The home was decorated and furnished to a very high standard and the domestic staff take obvious pride in making sure all parts of the home are well maintained. The home cares for people with dementia and the units are small and easily negotiated thus assist residents to find their way around. Staff have recently completed a very comprehensive infection control course.
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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, 28, 29 and 30 The owners expect to have sufficient, well-trained staff in place to meet residents’ needs. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Sycamore Lodge uses the Residential Forum guidance when calculating staffing levels. For the current dependency levels 776.70 care hours are needed per week. At present Sycamore Lodge core staff team consists of 6 staff during the day, 5 staff during the evening and 3 staff during the night. The manager for all but 14 hours a week is included in these numbers. The manager confirmed that currently 714 care hours but this figure had manually completed by using the forum calculations. Thus according to their calculations were above the staffing hours required but would adjust the staff hours to make sure they were meeting guidance. The owner said she would make sure the manager worked sufficient supernumerary hours to undertake her managerial tasks. SLW Limited has provided staff with access to a comprehensive range of training and is always making sure staff get up dated information. Staff have completed a range of NVQ’s and continue to further their education. 87 of the care staff have NVQ level 2 and some staff have completed level 3 and level 4 awards. Also ancillary staff have completed NVQ awards relevant to their job.
Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 Page 15 The staff recruitment procedures were in line with those required but small amendments were needed to the application form so it complied with the Disability Discrimination Act 1993. Occasionally staff that previously lived abroad apply for jobs. Currently the home does not have information about how to check whether work permits are satisfactory. Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 Page 16 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, 35 and 38 Quality Assurance systems are being introduced and will enhance the service. Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The manager has been checking and where necessary up dating policies and procedures. The policies she has produced are well written and easy to understand. Residents and staff were very complimentary about her skills and said she was very approachable. SLW Limited has employed an external consultant to design, introduce and train staff to use a quality assurance system. The owner expects this to complement the work they have already completed to achieve the Investor in People Award. Personal allowance systems were meeting the needs of the service. The manager undertook to test the system further to make sure it was completely robust.
Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X 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 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 2 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 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. Standard OP3 Regulation 14 Requirement The assessment record must assist staff to record information about all needs. Life histories must enable staff to gather useful information for the care of people with a dementia. Service users or their representatives must be involved in the writing of assessments. Residents care plans must 11/01/07 include in detail any restrictions or limitations that are currently in place. (Required at the last inspection – timescale 30/08/06) Care plans must continue to be developed as advised during the inspection. The manager must work sufficient supernumerary hours for the role she undertakes 03/05/07 Timescale for action 08/03/07 2. OP7 15 3. OP7 15 4. OP31 18 (1) (a) 16/11/06 Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 Page 19 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 OP27 Good Practice Recommendations The Residential Forum Guidance should be reviewed as residents’ needs changed and calculations should include activities, one-to-one support and difficulties caused by the building. The application form should comply with Disability Discrimination Act 1993 requirements. Advice should be sought from the Home Office around good practice when employing staff that previously worked abroad. 2. 3. OP29 OP29 Sycamore Lodge Residential Home DS0000015741.V304187.R02.S.doc Version 5.2 Page 20 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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