Inspection on 09/12/08 for Sycamore Cottage

This inspection was carried out on 9th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamore Cottage 16/06/08

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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sycamore Cottage Skippets Lane West Basingstoke Hampshire RG21 3HP     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kathryn Kirk     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Sycamore Cottage Skippets Lane West Basingstoke Hampshire RG21 3HP 01256478952 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Vanderslott6@aol.com Mr A Vanderslott Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 20 Number of places (if applicable): Under 65 Over 65 20 6 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 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. Care Homes for Older People Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our 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 inspections in June 2008 and September 2008. The findings of this report are based on several different sources of evidence. These included: A visit to the home by a regulatory inspector and a specialist pharmacist inspector, this Care Homes for Older People Page 5 of 27 took place on 9 December 2008. During this time four residents and two staff spoke about what it was like to live and work at Sycamore Cottage. Two visitors 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 parts of the building. The new manager was available to assist throughout the visit to the home. Five surveys were returned to us from relatives of people living at Sycamore Cottage.Three staff members also completed a survey. An Annual Quality Assurance Assessment (AQAA) was returned to us earlier in the year. 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. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the CSCI. What the care home does well: What has improved since the last inspection? What they could do better: This service remains rated as poor because of the evidence gathered regarding the management of peoples medications. The requirements which have not been met in this area need to be addressed before we can be sure that people are being properly cared for. Care Homes for Older People Page 7 of 27 Staff also need to have up to date training in other areas of health and safety and in understanding the needs of people who have dementia. The manager has made significant progress in improving the quality of care at Sycamore Cottage in a relatively short period of time. She needs to maintain this progress and also needs to apply to become registered with CSCI If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improved assessment procedures and information available, indicate that more consideration will be given about whether the service can meet assessed needs of prospective residents. Evidence: At the last inspection a requirement was made that the registered person must ensure that the service is suitable to meet assessed needs of prospective service users before they are admitted. The manager confirmed that there have been no new admissions to Sycamore Cottage since this time. She has however, devised two new forms so that information can be gathered about peoples health, care, social and cultural needs. She has also updated the Service User Guide and Statement of Purpose for the home. There is one inaccuracy in this as it says that the manager is registered. She has yet to apply for registration with CSCI. Care Homes for Older People Page 10 of 27 Evidence: Although the new admissions process has yet to be followed for prospective residents, systems are in place to help people to make an informed decision about whether Sycamore Cottage will be suitable for them . Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning has improved and staff have more information about peoples needs and wishes. Some medicaiton processes still place service users at risk. Evidence: At the last inspection a requirement was made that care plans need to include information about peoples wishes and expectations and need to take into consideration peoples capacity to make decisions. Since the new manager started care plans have changed and those seen had been updated monthly. They also included information about peoples preferences, for example when they like to get up and to go to bed. One service user reviewed their care plan with the inspector and confirmed that all information was accurate. The manager said that service users, where possible are involved in devising their care plans and that relatives are also consulted. This was confirmed by a visiting relative. Service users also have up to date moving and handling assessments in their bedrooms, one of these was seen in a bedroom viewed. This helps staff to offer appropriate support. The manager is also attending a course on the Mental Capacity Act and will cascade this training to staff at the home. This will Care Homes for Older People Page 12 of 27 Evidence: help staff understand further their responsibilities and peoples rights regarding capacity to make certain decisions. Care planning has therefore improved considerably. It would improve further if plans contained guidance about as required medications. This will be discussed further in the pharmacy part of this report. Through talking with the manager, it was evident that she is reviewing two current residents as their needs are changing. She is working with relevant professionals and relatives to ensure that Sycamore Cottage could continue to meet their needs. This was confirmed by a relative who visited the home. Health care needs are documented in care plans and appointments made and kept with health care professionals are recorded. One service user spoken with said that they had seen a dentist, chiropodist and had received a flu jab recently. Two visitors spoken with said that they felt that staff attended to the health care needs of their relatives and one visiting health care professional commented that staff appeared more focused since the new manager had started. Staff were observed to talk and interact with service users in a friendly and respectful way. Inspection Report for Sycamore Cottage Pharmacist Inspection 9.12.08 From the records and supplies of medicines in the home we could see that people do not always get their medicines at the dose and frequency that they are prescribed. Examples we saw included: A medicine prescribed to be given three times daily only when needed was being recorded as having been given every day. There was no care plan describing what was meant by when needed and detailing when this medicine was to be given. The manager confirmed that care plans were not in place for any medicines prescribed to be given only when needed. The same person had a medicine prescribed to be taken twice daily but it had frequently been given three times daily during the last month. One person had an iron supplement prescribed to be given three times daily but it had frequently been given four times daily during the last month. This same person had a gel prescribed to be applied twice daily but it had only been applied once each day during the last month. Another person had a medicine prescribed to be given twice daily but it was only being offered to the person in the mornings. This person was also prescribed an analgesic to be given four times daily when required but the records showed that it was only being offered in the mornings. There were also a large number of gaps in the records when medicines should have been given. As a result it is not possible to tell whether people got their medicines on these occasions. New procedures for the safe handling of medicines had been produced. These still lacked details of how tasks are to be completed in this service. This could lead to inconsistent practices being in place. Care Homes for Older People Page 13 of 27 Evidence: Medication was stored both securely and at the correct temperature for the protection of the service users. The medication trolley was clean and orderly, with the keys being held by the staff. Medicines are now supplied from the pharmacy in fully labelled containers, which includes the name of the person the medicine is prescribed for, the name and strength of the medicine and the dose and frequency to be taken. Controlled drugs were stored securely, but not in a cupboard that met the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. A recent change in the law means that all care homes must now keep all Controlled Drugs in a Controlled Drugs cupboard. The manager has informed us that a new cupboard has been delivered to the home. Additional records were kept of the usage of Controlled Drugs so as to readily detect any loss. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More consideration is now given to providing people with appropriate social and recreational opportunities. Evidence: The last inspection made a judgment that the service could improve by offering more diverse social and recreational opportunities particularly for those who needed additional support because of their degree of dementia. At the time of this inspection a number of improvements have been made. An activity coordinator has been employed for two hours every day during the week. On the day of the visit residents were taking part in a singing and musical session,those able to say, said that they enjoyed this very much and those that were not able to comment appeared interested and involved. Residents and staff showed craft items that they had made and one commented that they had enjoyed doing this. One service user was also being helped to write Christmas Cards by another staff member. Staff and relatives spoke about a firework party that had been recently held and the manager said that she has arranged for visitors from a local church to come to the home. A church service will also be held once a month. Relatives surveyed and spoken with generally felt that there has been an improvement in daily activities since the new Care Homes for Older People Page 15 of 27 Evidence: manager started. One said for example the new regime on how staff and residents interact is a positive step forward.our relative is now given small jobs to do ie wipe table tops off, which she obviously enjoys. Relatives who were asked Does the home help your relative to keep in touch Generally felt it did. Comments included no problems there Making us very welcome at all timesmy father regularly rings me up for a chat Since the last inspection a cook has been employed. One Resident said that they like the food and that they had plenty to eat. A new four weekly menu has been started as a result of listening to peoples views and there is greater choice, for example full fat milk is available as well as long life milk. Residents can now also choose between brown and white bread. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure has improved and adult protection processes are followed more consistently. Evidence: A requirement was made at the last inspection that the registered person must keep a copy of all complaints made and record the action taken. The complaints log was seen during this visit. It showed one complaint has been made since the last inspection. A record had been kept of what the complaint was and of the responses made both by the manager and the proprietor. This requirement has therefore been met. There is a copy of the complaints procedure on display in the home and there is also information about how to make a complaint in the service user guide. Relatives were asked has the care service responded appropriately if you or the person using the service has raised concerns about their care Three replied always and two said usually. Comments included especially since (the manager) came on board, she is a breath of fresh air Three staff who replied to a survey were asked Do you know what to do if a service user /relative has concerns about the home? All said yes A requirement was made at the last inspection that the registered person must confirm in writing all events which adversely affect the well being of any service user. Since this time records show that this has been done, and also indicate that adult protection procedures have been followed appropriately. This requirement has therefore been Care Homes for Older People Page 17 of 27 Evidence: met. An audit completed by the manager indicates that some staff need to undertake training in adult protection. This will be discussed again in the staffing section of this report. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the environment which is now more homely and comfortable Evidence: Since the last inspection the service has made a number of improvements to the environment These were listed in the managers action plan as follows: Carpets in dining room and lounge have been professionally cleaned All call bells are now fully working Fire evacuation plan has been written up and is displayed Door numbers are now on doors There are bins in all residents rooms There are table cloths, flowers and condiments on dining tables four new side tables have been purchased for tea/ coffee in residents lounge A new foot operated bin has been purchased for clinical waste There are signs on toilet doors Uplighters have been installed in the lounge Evidence was seen of all these improvements during the visit to the home.Visitors also agreed that there had been some changes for the better to the environement recently. One resident showed the inspector their room. It was clean and had been furnished to their taste. It was not very warm and this was brought to the attention of the manager who said that she would adjust the thermostat straight away. One visitor said that they felt further improvements could be made if the outside area was made more secure, so that in better weather his relative could spend some more Care Homes for Older People Page 19 of 27 Evidence: time outside. This was discussed with the manager who was already aware of this persons view and said that she intended to consider this when the weather became warmer. Since the last inspection the fire service had visited and had suggested further improvements. The manager said that these had been done. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The employment of domestic staff has enabled care staff to fulfil their own roles more effectively. Recruitment procedures help to protect service users Training needs to be completed to assist staff further in their jobs. Evidence: At the last inspection evidence was mixed as to whether there were enough care staff on duty at all times to meet the needs of servcie users. A recommendation was made that staffing levels should be reviewed. Since this time a cook and a cleaner have been employed to work on weekdays. A member of staff also has two hours of time allocated monday to friday for activities. On the day of the visit, there were two care staff on duty for the early shift and three on the afternoon shift. The manager was also present. Through observation it was evident that there were sufficient staff on duty to meet the needs of the thirteen current service users. The manager confirmed that there continue to be two waking night staff on duty each night. Relatives surveyed in general were satisfied with the staff. comments included they appear to handle all situations in a friendly and professional manner and the staff team has been very consistent The AQAA which was completed earlier in the year said that 8/17 staff have attaine dan NVQ level 2 in care and the manager said that two further staff were going to start this qualification in December 2008. Care Homes for Older People Page 21 of 27 Evidence: The previous inspection of June 2008 found that recruitement procedrues were thorough and one record of a new member of staff checked at the time of this site visit contained all the necessary documentation listed in the Care Homes Regualtions. Although training was judged to have improved at the last inspection the new maanger has undertaken an audit of training undertaken for all staff and this shows that some staff need either training or refresher training in key health and safety areas, for example fire safety and adult protection. Staff also need to have training in dementia care. The manager has training materials in these subjects, but has not yet had the time to organise training sessions. The poor recording in the drug administration sheets indicate that staff also need further guidance and training in this area . It will be a requirement that all staff complete training in key health and safety areas by 31 March 2009 Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well managed. Improvements made need to be sustained and in some instances continued, particularly in regard to the management of medicines Evidence: Since the last inspection a new manager has been appointed . At the time of the visit she had been in post just over two months and has made a number of improvements already discussed in this report. Visitors ,service users and staff all felt that she has made a positive impact upon the service and has improved the quality of life for service users. The manager has NVQ level 4 in Care and intends to study for her Registered Manager Award. She said that she has had 16 months previous experience as a manager in a care setting. She was advised that she will need to apply to CSCI to become registered. At the last inspection a requirement was made that the registered provider must make visits to the home as detailed in Regualtion 26 of the Care Home Regulations. This is one mechanism by which the quality of the service is monitored. Records show that Care Homes for Older People Page 23 of 27 Evidence: these visits were now taking place. The requirement has therefore been met. Staff do not handle any service users money, generally relatives are billed for chiropody or hairdressing. Some relatives have been unhappy about this process and have felt that the system needs to be made clearer and so this is an area where the service could improve further. The service user guide which has been revised by the new manager makes what is, and is not, included in the fees clearer. At the last inspection staff said that they received supervision and the new manager confirmed that regular supervision sessions continue to take place. There has also been a recent staff meeting, the minutes of which were seen. Records seen showed that there are new systemns in place to ensure that equipment in the home is working properly, for example, water temperature is monitored, fire safety and first aid equipment is regularly checked . Regular checks are also made to ensure that stair lifts and peoples wheelchairs are in good order. The manager has taken steps to ensure that the call bell system operates effectively. She has also updated risk assessments of all parts of the building. A requirement was made at the last inspection that the service must consult with the fire departement to ensure that fire safety arrangements within the home are satisfactory. Since this time, a fire officer has visited and fire safety matters are being considered under the fire services own regualtory procedures. As discussed in a previous section, medication procedures within the home need to improve. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 Staff must complete training 31/03/2009 in key health and safety areas and in dementia care Staff need to be supported to carry out all of their duties by having up to date information and guidance in these areas. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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