Inspection on 16/06/08 for Sycamore Cottage

This inspection was carried out on 16th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sycamore Cottage 09/12/08

Sycamore Cottage 17/12/07

Sycamore Cottage 05/06/07

Sycamore Cottage 04/10/06

Sycamore Cottage 25/10/05

Sycamore Cottage 05/05/05

Sycamore Cottage 07/10/04

Sycamore Cottage 15/04/04

Sycamore Cottage 30/09/03

Sycamore Cottage 23/01/03

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

CARE HOMES FOR OLDER PEOPLE Sycamore Cottage Skippets Lane West Basingstoke Hampshire RG21 3HP Lead Inspector Kathryn Kirk Unannounced Inspection 11:30 16 and 19th June 2008 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 Cottage DS0000011821.V365586.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. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Cottage Address Skippets Lane West Basingstoke Hampshire RG21 3HP 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) 01256 478952 Vanderslott6@aol.com Mr A Vanderslott Mrs K Vanderslott Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (6) of places Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th December 2007 Brief Description of the Service: Sycamore Cottage is a privately owned and managed care home registered to provide accommodation personal care and support for up to twenty residents over the age of sixty-five years with dementia. The home is situated in a private residential lane close to public transport within easy travelling distance of the main centre of the North Hampshire town of Basingstoke. The current fees charged ranged between £395- £440 per week. Sycamore Cottage DS0000011821.V365586.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 0 star. This means the people who use this service experience poor quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards (NMS) and Regulations. In particular, to follow up on the requirements made at the previous inspection in December 2007. The findings of this report are based on several different sources of evidence. These included: Two visits to the home, which were carried out on the 16th June 2008 and 19th June 2008. These visits lasted for a total of ten hours. During this time four residents and six staff spoke about what it was like to live and work at Sycamore Cottage. One visitor and one health care professional shared their views about the service. One care professional also provided some information over the telephone. The needs of the majority of residents are such that they are unable to verbally convey their opinions and so time was spent observing interactions between them and staff in the communal areas. Time was also spent looking at some records and in touring the building. The registered manager was not available during this inspection, but the responsible person, Mr Vanderslott was. Time was spent talking with him and with the newly appointed deputy manager. Three surveys were returned to us from relatives of people living at Sycamore Cottage. One staff member also completed a survey. An Annual Quality Assurance Assessment (AQAA) was returned to us prior to the visit. 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. After the last inspection we issued an improvement plan, which detailed where the service had fallen short of Care Homes Regulations and which explained why they should take action to remedy this. The manager responded detailing what action had been taken. This appeared to address all areas of concern. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 6 All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the CSCI. What the service does well: What has improved since the last inspection? There is more evidence that people/ their representatives are consulted when people are admitted to the home and when their needs are being reviewed. Care plans contain more up to date information and include guidance for staff in how to minimise any identified risk Staff have received further training in key areas, such as handling medicines, adult protection, moving and handling and infection control. There have been some improvements to the environment. The residual odour that was found in some parts of the home has been reduced by staff using specialised cleaning equipment and by replacing some soft furnishings. Staff training records have improved. The staff induction programme is more comprehensive and so will better equip new staff to understand their roles and responsibilities. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 7 The service has demonstrated that recruitment checks have become more thorough Staff supervision has improved and staff say that they feel more supported. What they could do better: The service needs to be able to demonstrate that proper consideration has been given about whether peoples assessed needs can be met at Sycamore Lodge before they are admitted. People’s care plans focus at present on identified areas of need. They could become more ‘person centred’ if they included more information about people’s preferences wishes and expectations. Medicine administration procedures need to be improved. The service also needs to ensure that it is following the latest guidance about the storage of some medicines. The range of social and leisure opportunities could be improved, particularly for those with more advanced dementia. The proprietor has recognised this and is intending to employ an activities co-ordinator. A detailed record of complaints must be kept so that the service can demonstrate that it is managing and responding to people’s concerns effectively. Correct procedures must always be followed in the reporting of incidents which adversely affects the well being or safety of any service user. The registered person should consult with the fire department to ensure that one person’s wishes for their bedroom door to remain open is respected, but that safety is not compromised. It was not clear whether there were enough staff to meet the care needs of everybody living at the home. Care staff were also required to carry out cleaning, cooking and laundry duties. Staffing levels in the home should be reviewed. Staff need to have an understanding of the Mental Capacity Act and how it affects the people that they are caring for. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 8 The management arrangements of the home remain unsatisfactory. There are no clear lines of accountability and although the deputy has made some improvements to the service, there are a number of areas in which the service does not meet National Minimum Standards and Care Homes Regulations. The evidence suggests that the service reacts to requirements made by the Commission, but is not proactive in identifying areas where improvements are needed. 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. Sycamore Cottage DS0000011821.V365586.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 Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 , Intermediate care is not provided and so standard 6 does not apply. Quality in this outcome area is adequate Information about peoples needs is gathered and service users and/ or their representatives are consulted during the admission process. However there is insufficient evidence that proper consideration is always given about whether the service can meet assessed needs appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Requirements were made at the previous inspections in June 2007 and December 2007 that service users and/or their representatives must be consulted as part of the admission process. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 11 The improvement plan written by the manager/proprietor said that this was now happening. Records seen showed that relatives had visited the home and discussed the prospective residents needs with staff before admission. Therefore the requirement has been met. During the visit, two files of recently admitted residents were seen. Both people had been referred through care management arrangements and it was evident that the service had obtained an assessment of need before the placement started. This contained information about health and social care needs as well as information about the persons mental health and any risks that had been identified in managing their care. The proprietor said that he had also visited the prospective residents in hospital and records showed that as part of these visits he had completed his own assessment. This was not very detailed and failed to fully consider whether they would be appropriately placed in Sycamore Lodge. One assessment said, for example, that the person was prone to falls and that they had some challenging behaviours. The proprietor said that he understood that this was not an issue at the time of admission. However, the person was given an upstairs shared room . It was not clear what consideration had been given to whether this person could manage to get upstairs using the stair lift ( with staff support ) or whether it was appropriate for them to go into a shared room. It was clear by the time of the second visit that the placement was not appropriate and the person concerned was moved back to hospital. A requirement has been made that the registered person must ensure that the service is suitable to meet assessed needs of prospective residents before they are admitted. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Care planning has improved but needs to continue to be developed to ensure that all aspects of a persons needs are considered. Some medication processes still need to be improved to further protect service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the previous inspections of June 2007 and December 2007 a requirement was made with regard to care planning;This was that a review of all care plans and risk assessments where appropriate must be undertaken involving the resident or their representative. Thereafter reviews of plans must be monthly with involvement of the resident or representative where possible. Since this time, a deputy manager has been employed who is reviewing the care planning process and records seen indicate that areas of risk have been Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 13 identified and that there is guidance for staff on how to minimise this. All files seen also showed that relatives had been shown current care plans and that they had agreed with their content. Files seen contained evidence that any changes in need had been recorded to ensure that plans contained accurate information. Although care plans had not always been reviewed every month they would appear to accurately reflect the physical needs of residents. One care professional said that care plans that they had seen recently contained more detailed information about how to support people. The requirement has therefore been met. Although the evidence was that there has been some improvement in care planning, what was less well documented was people’s capacity to make choices and what their preferences are in their daily routines, for example whether they prefer to bath or shower, and when they prefer to get up or go to bed. Files contained a form which asked questions about people’s likes and dislikes but those seen had not been filled in. Staff spoken with said that they felt that they had a good understanding of service users wishes and needs and said that they looked at care plans. Staff also said that information about changes in peoples needs was passed over at handover and that they felt that they had sufficient information to care for people appropriately. The service does not employ agency staff, so the same group of staff provide care. In terms of health care, records seen contained information to show that health care professionals continue to be accessed appropriately. The AQAA says that no service users have developed pressure areas in the past twelve months. The owner spoke about how staff, supported by district nurses, have helped to improve one service user’s skin condition. One visitor spoken with said that the home let them know very quickly about any changes in the health of their relative. People surveyed generally felt that the service gave appropriate care. Staff said that at present no service users administer their own medication. During the visit the administration of some medicines was observed. This process was not in line with Royal Pharmaceutical Guidelines, for example, one staff member signed the Medicine Administration Record (MAR) sheet but did not witness that the person that the medication had been prescribed for had taken it. This was because another staff member then took the medication to a different part of the building to give it to the service user concerned. The way in which this was being done could lead to errors. This was discussed with the proprietor and deputy manager at the time of the visit. They agreed that a more appropriate procedure would be followed. A requirement about this has been made. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 14 The storage of some medicines was discussed with the proprietor and he agreed to check with the pharmacist to ensure that all are being stored appropriately. A requirement has been made. The administration of “as required” medicines was discussed with senior staff and the provider. Staff were observed to ask service users if, for example, they were in pain at the time of the drug round. Medicines were then given, or not, depending upon the response. This is another area where care planning needs to be developed further. Care plans need to say when “as required” medicines should be offered and whether the person will ask for it if they need it. If the care plan tells staff to offer “as required” medicines at each drug round then a record should be kept on the administration sheet whether the person has had a dose or whether it has been refused. A register was being used to record some medicines, which was in addition to the MAR sheet. The latest guidance is that certain medicines should be recorded in a Controlled Drugs Register when they are given. This is considered good practice but is not a legal requirement. The register being used was loose leaf and did not meet Royal Pharmaceutical guidelines. A recommendation has been made that this guidance should be followed. Since the last inspection records show that staff have had further training in the management of medicines and staff spoken with confirmed that this was the case. The service was reviewed against the standards of privacy and dignity. Service users asked said that staff were nice and said that they treated them well. Staff were observed to knock on peoples doors before entering their room. Preferred forms of address were recorded in care plans and staff were heard to call residents by these names. Staff said that any medical examinations are carried out in peoples rooms, although some consultations were seen to be held in the private area of a communal room. Staff were observed to talk with service users in a friendly and kindly way although on occasion the language used was not very appropriate, for example one resident was called a “good girl” Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate The service could improve by offering more diverse social and recreational opportunities, particularly for those who need additional support because of their degree of dementia. Visitors are welcomed. People generally like the food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated earlier there is not very much information documented about peoples expectations and preferences. In the AQAA the registered manager stated that the home is going to employ an activities co ordinator . This has not yet happened but one member of staff spoken with said that she was hoping to take over this post shortly. She spoke with great enthusiasm about what could be achieved and said that she intended to go on relevant training to develop this role. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 16 There were activities taking place on both of the days of the visits including cards and singing and dancing. Residents who took part appeared to be enjoying these events. There were however a small number of residents who were wandering around without being engaged by staff. One wished to leave the building and was getting distressed. Some staff spoken with described how they would encourage residents to do other things when this happened, others were heard to ask the resident to sit down. On one occasion when a service user did leave the building staff needed guidance from the deputy manager as to how to manage the situation. This was given and the resident became calmer. Visiting is not restricted and one visitor spoken with said that they were always made to feel welcome by the staff. One resident said that they could see their family in private. People who returned surveys generally felt that the home helped their relative keep in touch with them. There was some reference on care plans to help people to exercise some control over their lives, for example “encourage to choose own clothing” However there was no evidence that staff had taken into account the implications of the recent Mental Capacity Act and how it affects residents within their care. A lunchtime meal was observed. Residents were seen to have a choice of two hot dishes. These were freshly prepared by a member of the care team who is currently responsible for cooking. Residents asked said that they had enough to eat and that they generally liked the meals. One resident confirmed that they had been asked what food they liked. Staff demonstrated a good knowledge of peoples likes and dislikes and they knew who needed to have a special diet because of medical needs. They also gave help where needed. One resident was observed to be given a sandwich between meals as he had requested this. Residents were observed to be given drinks between meals but it was apparent that in the main lounge there was not always enough space for them to put their drinks down. Some therefore had to keep hold of their cup. It was also observed that the hot drinks were served with long life skimmed milk. Staff said that fresh milk is delivered twice a week and that residents are happy with the long life milk. It was observed that some residents who had a hot drink asked to have a cold one instead and this was given. The menu for the day was on display in the dining room in written form. It has been discussed at previous inspections that residents may benefit from having menus displayed in other formats, for example pictures. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor The service does not demonstrate sufficiently how it has acted upon complaints and has not always followed the correct adult protection procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a written complaints procedure on display in the home. All relatives surveyed and residents spoken with said that they knew how to make a complaint and said that they felt that they would be listened to if they did. The complaints log was seen. This contained a reference to one complaint made in January 2008. It was recorded as resolved in May 2008 and it was evident that a meeting had been held to discuss issues raised. Mr Vanderslott provided further information, which was contained in the residents file regarding the nature of the complaint. It was discussed that the current level of information did not demonstrate satisfactorily that the service had followed its own complaints procedure and it was unclear what action, if any, had been taken as a result of the investigation. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 18 Staff spoken with were confident that they knew what to do in the event of someone making a complaint, or in the event of witnessing or being told of any abusive situation. Those asked were also aware of whistle blowing procedures. At the last inspection a requirement was made that all staff must have training in adult protection. Staff spoken with and records seen indicated that this is now taking place. One staff member said that they had not yet had the training but was going to do this shortly. The new deputy manager has also introduced a more comprehensive induction training pack, which meets skills for care standards and thus covers issues of protection. This requirement has therefore been met. The deputy discussed one incident during the visit that had occurred between two residents and said that this was being reported to adult services under safeguarding adults procedures. Adult services, were contacted afterwards, but did not have any record of this being done. Action had been taken to ensure that the residents involved were no longer at risk and the service had liaised appropriately with health care professionals for help and guidance, however, correct procedures should still have been followed. Similarly the service should have notified CSCI about the incident in writing by completing a Regulation 37 notice. This requires services to notify the Commission of specific events that affect the health and wellbeing of people who use the service. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate Some improvements have been made to the environment since the last inspection. Adjustments need to be made to some doors to ensure that peoples wishes are respected, whilst ensuring their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the past four inspections a requirement was made that the home must be kept free of unpleasant odours. Since this time there has been some improvement. The proprietor has purchased a sanitiser and some of the soft furnishings and carpets have been replaced. One social care worker confirmed that when they visited the home recently the odour in the home had reduced. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 20 They also said that in general there had been some improvements to the environment although said that sometimes the home was “dim” as staff did not always switch lights on and remarked that it had been cold on occasion. One other visiting professional commented that there was not very much indoor communal space for people who liked to walk about. This was observed to be the case during the visit. A tour of the building was undertaken as part of the visit. There was a faint odour in one communal room but no evidence that this was longstanding. The home generally appeared clean and tidy. The proprietor said that staff had worked hard to make Sycamore Cottage more homely. The décor and maintenance issues discussed in the previous report had been attended to. Commodes had been replaced and areas had been repainted. Most of the bedrooms were personalised and comments from some of the residents were that they liked their rooms. Two fire doors were observed to be propped open at the time of the first visit and one fire door was also wedged open at the time of the second. This was pointed out to the proprietor who agreed to act to remedy this. One door was open because a resident liked it this way. The proprietor said that he was looking into replacing this door with one with a self closing mechanism so that the persons wishes could be observed without compromising their safety. The service has infection control procedures in place and there was evidence that they were being followed, for example there was liquid soap and paper towels supplied in bathroom and toilets and staff confirmed that gloves and plastic aprons are always available. At the first visit some cleaning substances were placed in an unlocked cupboard in the bathroom. This was rectified straight away. The home has a contract with a clinical waste company to ensure bins are emptied regularly. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 29 and 30 Quality in this outcome area is adequate The service should continue to review staffing levels and staffing roles to ensure that they are employed in adequate numbers to meet residents changing needs. Training has improved. Recruitment practices have improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a rota on display in the building that reflects which care staff are on duty but does not detail management hours. The rota shows that a minimum of three care staff are on duty during the day. The deputy manager is also present. There are two waking staff employed at night. The proprietor also spends a lot of time at the home. Evidence regarding staffing levels was mixed and it is recommended that they are reviewed to ensure that they are sufficient to met all of the residents needs. Staff spoken with said that they felt that they had enough time to fulfil their roles and were observed to spend time socialising with some residents. As Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 22 discussed earlier some residents were however wandering or at times becoming distressed without staff engaging them effectively. One visiting professional expressed doubts about the level of staffing, and the AQAA indicates that three residents need two staff at any time to help with their care. Residents spoken with generally said that they did not have to wait too long for staff to attend, although one said that they had to wait sometimes to be helped to the toilet. The AQAA says that there are seventeen care staff employed. Only one person has left in the past year and no shifts are covered by agency workers. Residents therefore have a good continuity of care from people who know them. The AQAA also states that eight out of the seventeen care staff have attained NVQ level 2 or above in care and that seven of the staff are working towards this qualification The records of the two most recently recruited staff were seen. They included proof of identity, two written references and both had completed satisfactory CRB checks at the time of starting employment The service has therefore met the previous requirement that this check must be completed before staff are confirmed in post. At the last inspection a requirement was made that evidence of training must be held in the home and that staff must receive training in all health and safety courses. The service responded as part of the improvement plan providing details of courses that had been arranged. Staff spoken with during the visit confirmed that as well as doing their NVQs they received training every year. One for example said that they had completed training in moving and handling, first aid, handling medicines, dementia care, infection control and food hygiene. Records seen for one recently recruited staff member showed that that since February 2008 they had completed courses in emergency first aid, medication, food hygiene and moving and handling. This member of staff had also undertaken a very detailed induction programme. Records seen showed that all staff have recently updated their training in fire safety procedures. Relatives surveyed all thought that the staff had the right skills and experience to enable them to carry out their role effectively. The requirement regarding training has therefore been met. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 35 and 38 Quality in this outcome area is poor Although there has been some recent improvement, the home is still not being effectively managed. Lines of accountability remain unclear and this has a detrimental effect upon the running of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 24 Looking at previous inspection reports it is apparent that the service has suffered as the registered manager has not been in day to day control of the home since at least October 2006. A brief history of inspection reports illustrates this point:At the inspection of October 2005 when the manager was present, one requirement was made. At the inspection of October 2006 it was noted that the manager had been absent for some time and the report discussed a lack of direction for staff and people not knowing who was in charge. Eleven requirements were made where it had been identified that the home had fallen short of Care Home Regulations. Some improvement was noted in the report of June 2007 although the manager was still not in day to day charge. However, five requirements were still issued, two of them having been repeated from the previous inspection. At the inspection of December 2007 with the manager still absent, nine requirements were made. It is clear as a result of this inspection that there remain a number of areas where the outcomes for people who use the service are adequate or poor. All people who were asked said that they had not seen the manager for a long time. Mr Vanderslott said that the manager continued to deal with some of the paperwork for the service. We wrote to Mr Vanderslott in January 2008 with our concerns about the management of the home and Mrs Vandeslott responded saying that she was not at present able to work full time. She said that a deputy had been employed to work with Mr Vanderslott to ensure that standards return to an acceptable level. The deputy manager has many years of experience as a psychiatric nursing sister and as a Community Psychiatric Nurse. She said that she comes to the home between 20 and 25 hours a week although on the week of the visit she had worked longer to support staff. She was seen to manage situations competently and to guide staff effectively. Staff said that they felt that she offered very good support. There was also evidence that she has improved some systems within the home, for example care planning and staff supervision. However, as she has had a break from practice there are areas in which she said she needs to increase her knowledge and skills, for example in her understanding of the Mental Capacity Act. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 25 The proprietor said that he is present about five hours a day. It was evident that he carries out some of the managerial tasks, for example he completes the initial assessment of people before they move to Sycamore Cottage. This caused some difficulties at the time of the visits as the deputy had not had the opportunity beforehand to view the assessments of two people who had been admitted that week. At the last inspection a requirement was made that an effective quality assurance system should be in place seeking the views of service users. Since this time a survey has been conducted. Eleven out of eighteen relatives completed these on behalf of residents. Results seen showed that these were mainly positive, and Mr Vanderslott said that any issues raised had been addressed. The service has therefore sought the views of service users or their representatives. Under Care Home Regulaltion 26, Mr Vanderslott is required to prepare a monthly written report about the conduct of the home, after looking at records, inspecting the premises and talking with residents, their representatives and staff. In this way the quality of service can be monitored on a regular formal basis. Mr Vandeslott said that he had not completed a report for some time as he felt that he was present so often that he knew what improvements were needed. He did however produce a report at the time of the second visit to the home, although this only covered issues which had been raised by the inspector at the initial visit, for example fire doors being wedged open. Staff confirmed that they now receive regular supervision and feel well supported. Records seen also reflect that regular supervision sessions now take place. The requirement issued regarding supervision which was issued at the last inspection has therefore been met. As discussed earlier, staff say, and the AQAA confirms, that they receive training in safe working practices. The AQAA also confirms that equipment within the home is regularly serviced and maintained. Records seen for fire safety equipment corroborated this. As discussed in a previous section action needs to be taken to ensure that fire doors meet needs. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 26 Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 27 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 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 3 X 2 Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13.2. Schedule 3.3(i). Requirement The same person who administers medication must sign to say that they have done so. The registered provider must carry out visits as required by regulation 26 The registered person shall not provide accommodation to a service user unless they have confirmed in writing that the care home is suitable to meet needs in terms of health and welfare. The registered person must keep a copy of all complaints made and record the action taken The registered person must confirm in writing all events which adversely affects the well being of any service user. The registered person must ensure after consultation with the fire authorities that they take adequate precautions against the risk of fire. DS0000011821.V365586.R01.S.doc Timescale for action 17/07/08 2. OP33 26 30/07/08 3. OP4 14(1) 17/07/08 4 5. OP16 OP18 17(2)© Schedule 4 37, 17/07/08 17/07/08 6 OP19 23(4) 30/07/08 Sycamore Cottage Version 5.2 Page 29 7 8 OP9 13(2) 15 OP7 The registered person must ensure that all medicines are stored appropriately. Care plans need to include information about peoples’ wishes and expectations and need to take into consideration peoples capacity to make decisions. 16/08/08 16/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP27 Good Practice Recommendations The register used to record some medicines within the home should meet Royal Pharmaceutical guidelines. The service should review staffing levels to ensure that there are sufficient care staff on duty at all times to meet need. Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sycamore Cottage DS0000011821.V365586.R01.S.doc Version 5.2 Page 31 - 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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