CARE HOMES FOR OLDER PEOPLE
Sycamore Cottage Private Residential Home 14 Harborough Road Oadby Leicestershire LE2 4LA Lead Inspector
Fiona Stephenson Unannounced Inspection 20th April 2006 09:30 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 Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 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 Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sycamore Cottage Private Residential Home Address 14 Harborough Road Oadby Leicestershire LE2 4LA 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) 0116 2711720 0116 2711880 Sycamore Cottage Limited Vacant Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. To be able to admit a person under the category of DE(E) named in variation application number V29043 dated 2nd January 2006. To admit the named person in the category DE/E who is the subject of variation application V29359. 5th September 2005 Date of last inspection Brief Description of the Service: Sycamore Cottage is a residential care home for a maximum of 14 older people. There are currently two residents with dementia related conditions. The home is situated off the Harborough Road in Oadby, and is close to local shops and supermarkets. The home is a converted detached house with a ground floor extension. There are 10 single bedrooms and two shared bedrooms. The first floor comprises of five bedrooms and a bathroom that is accessed by a stair lift. The communal areas include a lounge and dining room. There is a courtyard and garden to the rear of the property. The range of fees for the service is between £280 and £380 per week Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection that included a visit to the home, and inspection planning. Prior to the home visit, the inspector spent half a day reviewing the last inspection report, and information relating to the home received since that inspection. The visit took place on Thursday 20th April from 9.20am to 4.00pm. During the course of the inspection, the inspector checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means that the inspector looks at the care provided to two residents living at the home by talking with the residents themselves; talking with staff supporting their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. The inspector also checked other issues relating to the running of the home including health and safety, and management issues. During the visit, the inspector also spoke with other residents living at the home, and two people visiting a resident. What the service does well: What has improved since the last inspection?
The new owners of the home are currently undertaking a re-decoration programme to improve the fabric of the home. The staffing records now comply with the care home regulations and include criminal record bureau checks, two written references and documents providing evidence of staff qualifications. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 6 What they could do better:
Errors were noted in the dispensing and recording of medication, potentially compromising the health and safety of residents living at the home. Management must ensure that staff are suitably trained and supervised to ensure that errors do not occur. The surface temperature of many radiators in the home was high, and could potentially be a hazard to residents if they fell against them. These hadn’t been checked as the expectation was that the boiler system had kept the temperature to a safe level. Management must ensure that the surface temperatures of radiators are safe. Care plans are adequate, however they could be improved to give more comprehensive information about the care needs of residents in areas such as nutrition, mobility, personal hygiene, medication, psychological and emotional needs. These would provide staff with a greater understanding of the needs of each individual resident that would then support them in improving the provision of care. Residents are happy and enjoy their food, however there is currently limited planning of the menu to ensure that nutritional needs are met. The management could devise a system to ensure that there is the right balance between meeting residents food choices and providing healthy food. Although staffing at the home is generally sufficient to meet the needs of Residents, the level of staffing from 7.00am to 10.00am could be looked at. This is a busy time in the home with residents waking up and getting dressed, as well as breakfasts being made. Staff currently at times, have to work between the kitchen and be involved in care duties. This is not acceptable in terms of health and hygiene because it increases the risk of cross-infection. Management could consider revising the staff rota to deal with these issues. Activities are provided to residents during the week, however the home could continue to improve on its delivery of activities to enhance the quality of life of people living at the home. Although the home is clean and tidy, one bedroom was identified as having an unacceptable odour. Management should ensure that the odour is eliminated. Management could improve induction training for staff, and ensure that staff have a clear understanding of the policies and procedures relating to Safeguarding Adults, and procedures relating to ‘Whistle Blowing’. The time provided to the manager to undertake management tasks such as record keeping, supervision, and care reviews could be improved to ensure such tasks are completed well. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 7 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 Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 8 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 Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 9 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. Quality in this outcome area is adequate; this judgement has been made using the available evidence, including a visit to the service. Residents’ needs are adequately assessed prior to moving into the home. EVIDENCE: The inspector checked the care records of two residents who were case tracked. The pre-admission records of one resident were not available at the time of the inspection, and the inspector judged the assessment to be adequate based on the information given by the manager. The second preassessment record was undertaken by social services, and it was clear through observation that staff were meeting this resident’s needs. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The health and personal care needs of residents are satisfactorily met. EVIDENCE: The care plans of both residents’ case tracked were checked. They were found to provide adequate information about the care needs of each resident, however they were not detailed and didn’t encompass all aspects of the health, personal and social care needs of residents e.g. care plans for nutrition, care plans for medication, care plans for moving and handling. They also were not reviewed as regularly as would be good practice, and were not signed by the resident to confirm they had been consulted as part of the process. Residents have good access to health care services, and records of G.P visits are good. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 11 The majority of staff have been trained in the administration of medication, however trained staff made errors in the administration and recording of medication. Three medication record sheets were checked, and all showed errors. The manager has not put adequate checks in place to ensure that medication is being given correctly. Staff were observed as treating residents with respect, and residents informed the inspector that they were happy with the care provided to them. Visitors are welcomed, and many residents continue to have good social contacts with people living outside of the home. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 12 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): 12,13,14,15. The quality outcome for this area is adequate. This judgement has been made using the available evidence including a visit to the service. Daily life and social activities within the home are satisfactory. EVIDENCE: Breakfast at the home is between 7.00am and 9.00am, although residents have the choice to stay in bed longer in the morning. There are planned activities within the home, and residents occasionally go out of the home for lunches and coffees. There is limited evidence to suggest that the activities are linked to the individual preferences or interests of residents living at the home. Bingo was played with the residents in the afternoon, however apart from this activity many residents spent the rest of the time sitting in their chairs in front of the TV which had been on throughout the day. Of these, some were clearly not interested in what was being televised, however there was nothing else to occupy their time. Residents have the choice to spend time in their rooms, or to stay in the communal living room. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 13 Residents said they enjoyed the food provided at the home, and on the day of inspection they received baked fish, with chips and mushy peas from the chip shop. There is not at present a planned menu, and currently meals are planned on a daily basis. The owners are putting together a four weekly menu, although this has yet to be put into practice. Records relating to the nutritional requirements of each resident are inadequate and therefore staff cannot check whether the meals provided give sufficient nutrition to each individual resident. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents feel able to talk to management about concerns. EVIDENCE: Residents informed the inspector that they felt able to talk to the manager and staff if they were unhappy about any aspect of care. The complaints procedure was checked and the inspector checked to see if there had been any complaints since the last inspection. The records showed that none had been logged. The CSCI has also not received any complaints or concerns since the last inspection. The inspector asked staff about how they would deal with a situation if they saw a resident being abused by another member of staff. The staff member spoken with said that it was unacceptable and would expect the person to be dismissed, however did not have any understanding of who outside the home would need to be contacted to undertake an investigation. Discussions with management also indicated that staff had received limited training and information on this subject. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 15 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): 19,20,21,23,24,25,26. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents live in a generally safe and well-maintained environment. EVIDENCE: The inspector checked the communal and bedroom areas of the home. These were generally found to be clean and tidy, and the bedrooms were personalised with small items of personal furniture, ornaments and pictures. Improvements are currently being made to the décor in the home. During these checks it was noted that the surface temperatures of some radiators in the hallway and some radiators in the bedrooms were very high and could potentially burn residents if their skin came into contact with them, particularly if they fell against them. The owner informed the inspector that the boiler had been set up to provide a safe surface temperature, and would look into this immediately. The radiators were turned down during the inspection. Although the bedrooms were clean and tidy, a smell of stale urine was noted coming from one of the bedrooms.
Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 16 The inspector was informed of the cleaning routine relating to the carpets in this room, however they did not include regular shampooing that could eliminate the smell. One bedroom had a socket coming out from the wall and was dangerous. This was taken out of action during the inspection visit. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The numbers and skill mix of staff is generally satisfactory in meeting residents’ needs. EVIDENCE: Staff records demonstrated that criminal record bureau (CRB) checks have been made and that references have been taken up. Records also demonstrated that staff had received relevant training in moving and handling procedures, first aid, basic food hygiene, and basic dementia care training. The owners informed the inspector that 50 of the staff had National Vocational Qualification in Care to a level 2 standard. Staff are provided with training at the start of their employment (induction), although through discussion with the manager and owner, it became evident that further work is required to ensure staff are clear about policies and procedures. The majority of residents at the home do not need high levels of care and therefore the current staffing levels at the home are in general sufficient to meet their need. However, during 7.00am to 10.00am staffing levels are insufficient to allow staff to provide good personal care to residents on waking and getting washed and dressed, and at the same time provide breakfast and give residents their medication. The inspector was informed of how staff on duty in the kitchen, had to at times move from the kitchen to provide personal care to residents; and the medication records indicated errors at this time of the morning. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 18 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): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Residents live in a home that is run by a manager who is of good character, but who does not always have enough time available to undertake management tasks. EVIDENCE: The manager has been in post for one year, however as yet has not applied to the Commission for Social Care Inspection to become the registered manager. She demonstrated a high level of commitment to the job, and a growing understanding of the complexity of the job. The inspector noted that the manager has insufficient time to develop care plans, provide sufficient supervision to staff, and to undertake necessary paperwork as she is often working as a carer or in other roles within the home.
Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 19 Through discussion there appeared to be a lack of clarity as to the roles and responsibilities between the manager and the owners who also work at the home, for example the manager was unaware of paperwork relating to a resident which had been undertaken by the owner. The inspector checked records to ensure that their money was safeguarded and was satisfied that this was so. The owners have put together a questionnaire to send out to visitors and relatives, and to give to residents, to enable them to improve their service. This is being sent out in the near future. The cupboard that houses cleaning products is situated above the heads of staff and has to be accessed by staff via a step ladder. The inspector was concerned that this might be hazardous to the safety of staff and asked the manager to consider undertaking a risk assessment on this. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 20 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X 3 3 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? None 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 OP25 Regulation 13 (4)(c) Requirement Ensure the surface temperature of radiators do not pose unnecessary risk to the health or safety of service users. Ensure there are effective systems for the recording, handling, and administration of medicines received into the care home. Timescale for action 04/05/06 2 OP9 13(2) 04/05/06 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 OP31 Good Practice Recommendations Consider providing the manager with more time to undertake management tasks such as record keeping and supervision. Ensure there are clear lines of accountability between the manager and the owners. Ensure the unacceptable odour from the identified bedroom is eliminated. 2 OP26 Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 22 3 OP7 4 5 6 7 OP15 OP12 OP27 OP18 Improve care plans to provide comprehensive information about the care needs of residents in areas such as nutrition, mobility, personal hygiene, medication, psychological and emotional needs. Ensure that care plans are regularly reviewed and revised as necessary. Ensure there is the right balance between meeting residents food choices and providing healthy food. Further improve the range and delivery of activities to enhance the quality of life of people living at the home. Consider revising the staff rota to ensure that there are sufficient staff on duty to undertake all tasks safely and effectively during the busy early morning period. Improve induction training for staff, and ensure that staff have a clear understanding of the policies and procedures relating to Safeguarding Adults, and procedures relating to ‘Whistle Blowing’. Sycamore Cottage Private Residential Home DS0000062462.V289938.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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