Inspection on 15/09/08 for Sycamore Court

This inspection was carried out on 15th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamore Court 17/08/09

Sycamore Court 23/02/09

Sycamore Court 17/03/08

Sycamore Court 28/06/07

Sycamore Court 31/01/07

Sycamore Court 15/05/06

Sycamore Court 14/10/05

Sycamore Court 07/05/05

Sycamore Court 13/09/04

Sycamore Court 22/04/04

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Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sycamore Court Magpie Lane Little Warley Brentwood Essex CM13 3DT     The quality rating for this care home is:   one star adequate 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: Michelle Love     Date: 1 5 0 9 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. the things that people have said are important to them: They reflect 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 39 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 39 Information about the care home Name of care home: Address: Sycamore Court Magpie Lane Little Warley Brentwood Essex CM13 3DT 01277261680 01277202028 sycamorecourt@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Peter Edward Watchorn Type of registration: Number of places registered: Southern Cross Healthcare (West) Limited care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Sycamore Court is a purpose built, two storey building situated in a rural location outside Brentwood/Warley and within easy access of A127 and M25. The home provides accommodation for 39 older people on two floors, in 39 single en-suite rooms. Other facilities include 4 lounges and separate dining areas. In addition the home benefits from a specially equipped hairdressing salon. A passenger lift provides access to all levels within the home. There are large open grounds with excellent views across the local countryside and a patio area with seating. Car parking facilities are available to the side of the property. The home is not serviced by any public transport. Brentwood station is approximately 3 miles away and the nearest bus stop is advised as approximately a 40 minutes walk. Care Homes for Older People Page 4 of 39 Over 65 39 0 Care Homes for Older People Page 5 of 39 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: one star adequate 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: This was an unannounced key inspection. The visit took place over one day with two inspectors and lasted a total of 10 hours, with all but one key standard inspected. Medication practices and procedures were examined by a specialist pharmacist inspector. Additionally, the managers progress against previous requirements from the last key inspection was also inspected. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment (AQAA). This is a document that is required by law which is completed by the provider, detailing what they do well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally Care Homes for Older People Page 6 of 39 a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to this inspection surveys were forwarded from the Commission for Social Care Inspection to residents next of kin, placing authorities, healthcare professionals and staff who work within the care home. At the time of writing this report only 1 staff survey had been completed and 3 relatives surveys received. Comments are highlighted within the main text of the report. Following the last key inspection to the home whereby concerns were raised in relation to care planning, risk assessing, reviewing of individuals care needs and failure to meet and monitor residents needs in relation to nutrition, a Statutory Requirement Notice was issued. A further random inspection was conducted on 11/6/2008 to assess compliance with the requirements set out in the Statutory Requirement Notice. Although at this site visit, some improvements were noted, further shortfalls were identified which indicated that the above Statutory Requirement Notice had not been fully met and people living at Sycamore Court remained at risk. As a result further legal advice was sought and enforcement action taken. As a result of the above action and from evidence at this inspection, it is evident that some improvements have been made to ensure positive outcomes for people living at Sycamore Court. What the care home does well: What has improved since the last inspection? What they could do better: Further development is required to ensure that every person who is admitted to Sycamore Court irrespective as to whether they are admitted on a respite basis or as a Care Homes for Older People Page 8 of 39 permanent resident have a plan of care that clearly records their care needs, how these are to be met and is person centred. Additionally there are clear risk assessments, detailing the specific nature of the risk and how these are to be minimised. This will ensure that staff working within the care home are fully aware of the individual persons care needs and are able to deliver care in line with these requirements. Staffing levels at the home need to be improved and maintained so as to ensure residents safety and wellbeing. Staff recruitment procedures need to be improved to ensure that residents are safe. Further training and personal development is required for staff to ensure that they have the skills and competence to meet residents needs and to deliver good care. 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 9 of 39 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 10 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can expect to be assessed prior to admission and are assured that their care needs can be met. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the management team are able to meet the prospective residents needs. In addition to the formal assessment procedure, supplementary information is sought from the individual residents placing authority and/or hospital. Additionally formal assessments are completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. Two care files for the newest people (1 respite and 1 permanent) admitted to the home were examined. Records showed that a pre admission assessment was completed for both people prior to their admission to the care home, however some elements of the pre admission assessment for one person were observed to have not Care Homes for Older People Page 11 of 39 Evidence: been completed. This means that staff working within the care home may not have sufficient information so as to compile the persons individual care plan and/or have insufficient information about how to meet the needs of the individual person. It was unclear from discussion with either person as to whether or not they visited the home prior to admission or if their representative had had an opportunity to visit Sycamore Court as part of the pre admission process. No information to confirm the above was recorded within either pre admission assessment documents. On inspection of the pre admission assessment, there was no evidence to show this had been compiled with the resident and/or their representative. The home does not provide intermediate care. Care Homes for Older People Page 12 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care as they would wish it, however shortfalls in recording may mean that peoples wellbeing is not always regarded. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by staff who work in the care home. As part of this site visit 5 care files were examined (1 respite care file and 4 permanent care files). It was noted that following the last key inspection, care plans for individual people have been reviewed, updated and where appropriate rewritten. Evidence at this key inspection shows that efforts have been made by staff to improve the quality of the care planning processes and to record individual peoples care needs and how these are to be met by care staff. The general recording within some peoples care plans was observed to be much more detailed and informative, provding a good basis to staff so as to ensure that care provided was reflective of individuals care Care Homes for Older People Page 13 of 39 Evidence: needs,however this was not consistent. Care must be taken by staff to ensure that care needs highlighted within placing authorities assessments are recorded and transferred to individuals care plans, so as to ensure that staff have the most up to date information about the individual person and the potential risks identified. This refers specifically to one persons assessment recording that the person was at risk of fluctuating health pertainig to their physical care needs and being allergic to penicillin. Neither of the above issues were detailed within the care plan and no risk assessments had been devised. The care file for one person receiving respite care, was poorly completed and related solely to one aspect (close observation), with no other areas mpleted. This was verified by the homes deputy manager and the services operations manager. The assessment undertaken by the persons placing authority clearly recorded them as having a range of care needs pertaining to their personal care, small appetite and poor communication. Risk assessments were completed for two areas however the risk relating to falls was not highlighted as a care need. The AQAA recorded under the heading of what we do well, a comprehensive care plan is drawn up on admission. This statement did not fully concur with the above findings of the inspection. As a result of the above an Immediate Requirement Notice was issued. Much improvement was noted in relation to the documentation of nutritional needs/records for individual people, however there were some inconsistencies.The record for one person showed they had lost a significant amount of weight. There was evidence to show that the care plan had been reviewed and updated to reflect the above and as a result of the change of needs the persons weight was now monitored weekly rather than monthly. There was also evidence to show that the person had been seen by a healthcare professional.This was in contrast to another care file examined relating to the persons poor nutrition. Records showed that this persons care file had not been rewritten since 2006. Although there was evidence to show that the care plan was regularly reviewed, it did not reflect that since mid August 2008 the person had lost approximately 4KG in weight. On inspection of the professional visitors record between January and September 2008, there was no record of a healthcare professional being contacted for advice or providing any interventions relating to weight loss. The homes action plan dated 12/9/2008 details, All care plans have been rewritten and reviews are being carried out as changes and circumstances occur. The operations manager confirmed that the above had been achieved but was disappointed that the above care plan had not been reviewed and/or rewritten. The care file for one person evidenced they had care needs relating to their poor mental health. No information was recorded detailing for staff the steps to be undertaken should this persons mental health deteriorate. Although a risk assessment Care Homes for Older People Page 14 of 39 Evidence: was devised relating to the above, information recorded was insufficient identifying how the risks were to be minimised. The same care file recorded that the person could be non compliant in relation to their medication, however no risk assessment was devised detailing how the risk was to be minimised. We acknoweldge improvements made since the last key inspection, however further development is required to ensure that care plans are person centred and include all individuals care needs and appropriate risk assessments. The AQAA details under the heading of our evidence to show that we do it well, care plans and risk assessments are in place evidencing all our service users needs and how we meet their needs and under the heading of what we do well, we evaluate the care plans monthly, as a minimum, and update them should there be any changes. The above statements did not fully concur with the inspectors findings. One persons review records stated, [name of resident] said that they are very happy about the care. Other residents spoken with also confirmed that they like living at Sycamore Court and feel that their care needs are met by staff working at the care home. On inspection of 6 surveys (internal) from relatives, all were complimentary regarding the care provided at Sycamore Court and felt their member of familys care needs were adequately met. One healthcare professional commented that they felt that staff working within the care home worked under a lot of pressure, however efforts were made by staff to follow their instructions as much as possible and that they were responsive with prompting and encouragement. Additionally they advised that the majority of staff appeared to know residents well. Practices and procedures for the safe use and handling of medication were examined by a pharmacist inspector. Storage for medication on both floors is adequate and is now temperature controlled using air coolers. Daily records are made of the temperatures which were consistently below the recommended maximum of 25C. On arrival on the first floor, the door to the storage room was unlocked and although the medication trolley stored there was locked, the fridge used to store medicines was not. The room was also unlocked and unattended at lunchtime and on a further 2 occasions during the afternoon. The fridges used to store medicines are adequately controlled and daily temperature records show the temperatures consistently between 2 and 8 C. There were opened and used eye drops in each fridge which were not dated on opening and since these must be used within 28 days of opening could therefore be used after this date and put residents at risk. The requirement made on the last inspection that medicines are stored under suitable environmental conditions has therefore been met. Dedicated storage is provided on the ground floor for controlled drugs but this cupboard does not comply with the Misuse of Drugs (Safe Custody) Regulations since it is not fixed properly to the wall. This was noted on previous inspections and it was Care Homes for Older People Page 15 of 39 Evidence: expected that this would be managed by the home. This has not been done and so a requirement has been made. Following the inspection the companys estates manager arranged for an external party to investigate the above. We have been advised that the controlled drugs cupboard is deemed compliant with the above regulations. This will be reinspected at the next inspection. We watched some medication being given to residents at lunchtime. The carer was seen to give medication to residents with due regard to their personal choice but on each occasion she left the medication trolley open and unattended in the corridor outside the dining area while giving medication to residents in either the lounge or dining room. Three residents were seen to walk past this open trolley unsupervised and they could therefore have had unauthorised access to medicines. This and the unlocked storage room seen on a number of occasions is an unacceptable security risk. Medication is recorded as being given to residents as prescribed and so the requirement made at the last inspection has been met. Records made when medication is received into the home are reasonably good as are records made when medication is given to residents. There were very few discrepancies in the medication or records and evidence was seen that the records are checked regularly by staff. This concurs with the AQAA which stated that staff check MAR sheets at handover and identify any discrepancies. Despite this however, some discrepancies were found such as: Medication given in variable doses e.g. one or two tablets but where the actual dose given is not recorded in all cases. Medication due on the day after the inspection and the record had already been signed. Medication for one person had run out three days before the inspection but little action taken to ensure continued supply by contacting the residents GP. Some Hand-written MAR sheets did not clearly indicate the month and year of use The quality of medication records has improved markedly over previous inspections, the requirement made after the last random inspection in June 2008 that people are protected by having suitable arrangements in place for the control, administration and recording of medicines had almost been met in full but given the few discrepancies noted above has been carried forward with a new timescale for action. In addition to this, entries on hand-written MAR charts were not signed as being checked for accuracy. The homes own policy states All hand-written prescriptions should be witnessed by two seniors and signed. The AQAA told us that Only staff who have received medication training from Boots have contact with the medication. We looked at training records and 2 of the 12 staff members authorised to administer medicines have no docmented training. Of the Care Homes for Older People Page 16 of 39 Evidence: remaining 10 people only 5 of these have a documented assessment of competence to administer medication safely. Following our inspection in April 2008 we were provided with an improvement plan to meet the requirements made and this stated that Medication training to be implemented to all senior staff and Medication competency assessments to be completed for all staff administering medication. The timescale for this to be completed was 31st May 2008 and was to be done by the Home Manager. The response to our requirements following the random inspection in June 2008 was that All senior staff will complete the Boots Foundation course (by 1st July 2008) and Medication competency assessments will be conducted with all senior staff (50 by 17th July 2008 and remainder by 31st July 2008). This has therefore not been achieved. During observation of the medication round a staff member was unsure of what action to take when she noticed a discrepancy in the medication and had to be guided by the inspector as to what to do. This raises questions about staff competence. Care Homes for Older People Page 17 of 39 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. Residents can be assured that their social care needs will be met and that they will receive a varied diet that meets their needs. Evidence: An activities co-ordinator is employed at Sycamore Court for 30 hours per week Monday to Friday each week. A copy of the activity programme is displayed on both the ground and first floor corridors. Consideration should be made to devise the activity programme in both a written and/or pictorial format so as to ensure that people living at the care home are able to make an informed choice. As stated at the previous inspection, the activities co-ordinator has completed taining from NAPA (National Association for Providers of Activities for Older People) in 2007 and training in dementia care. On inspection of individual residents activity records, a Map of Life had been completed detailing their personal preferences, likes and dislikes and those people important to them in their life. Of those people case tracked, records pertaining to activities undertaken were recorded. On inspection of the 4 week rolling activity programme, this showed that people living in the care home are able to participate Care Homes for Older People Page 18 of 39 Evidence: within a varied range of activities such as board games, bingo, ball games, baking, ladies afternoon, arts and crafts, hairdressing, reminiscence, mens morning, film afternoon, quizzes, gentle exercises, coffee morning and external entertainers. One relative survey recorded that they were pleased that their member of family had been given the opportunity to go to the local theatre. In addition to the above, 2 people receive daily newspapers and 2 people receive a weekly television magazine. This was confirmed by 2 people spoken with. The activities co-ordinator advised the inspector that she is hoping to introduce memory boxes and objects of reference in the future. Residents spoken with confirmed that they were able to choose as to whether or not they participated within the activity programme and 3 people confirmed that they enjoyed the activities provided. One person stated, the entertainers are great, really enjoyable. In addition to the above, a newsletter has been devised for both residents and relatives. The AQAA details that an activities schedule has been compiled taking into account residents interests and personal preferences. The activity folder is available within the reception area and provides information on forthcoming events. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. The AQAA details under the heading of our plans for improvement in the next 12 months, once we have finished refurbishing, we would like to turn two small lounges into private family rooms where service users can enjoy private time with their families if they come to visit. On the day of inspection the menu displayed in the dining room on the ground floor was inaccurate as it was for the previous day. Consideration should be made to devise the menu in larger print and/or pictorial format so as to ensure that people living at the care home are able to make an informed choice. Staff should also consider advising people as to the menu of the day prior to the meals provided to remind people of the choices made the previous day/available. Of 5 people spoken with at lunchtime, none were able to advise as to the lunchtime meal choices available. There is a rolling 4 week menu and records showed there is a varied choice of meals throughout the week and alternatives to the menu. The delivery of the lunchtime meal was observed within the ground floor dining room and the teatime meals were observed on both the ground and first floor dining rooms. Dining tables were attractively laid with tablecloths, small vases of flowers, serviettes, cutlery and a range of condiments. People were observed to be offered a choice of drinks. Meals provided to residents were seen to be plentiful and attractively presented. Where individual people required assistance, staff were observed to undertake this with sensitivity and with due care and attention. Staff were attentive to peoples needs and the meals were observed to not be rushed. Comments from residents in relation to the meals provided were noted to be positive and included, the Care Homes for Older People Page 19 of 39 Evidence: food is really good, I really like the food and the food is lovely. The only negative comments related to an insufficient choice of drinks provided during morning and afternoon tea. One resident stated, I really like coffee, but no matter how often you ask, you never get it. Another person spoken with confirmed the above, but stated that the choice of nightime drinks was better. On inspection of a survey undertaken by the management team of the home for relatives, this recorded, when for some reason or another there is no cook, the food is unedible (tough meat, burnt veg and pudding), has been much better recently and sometimes the salad is sparse on Fridays. Care Homes for Older People Page 20 of 39 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. Residents concerns and safety are safeguarded by robust systems. Evidence: There is a corporate complaints policy and procedure in place and this is detailed within both the Statement of Purpose and Service Users Guide and displayed within the main reception area. On inspection of 2 relatives surveys forwarded to us, both confirmed they were aware of how to make a complaint. Additionally 3 residents spoken with confirmed that if they had a concern and/or an issue, they would tell staff. The AQAA details in addition to the above, the manager operates a managers surgery once weekly to enable family members and other interested parties the opportunity to come in at their leisure to meet with the manager so as to discuss any issues/areas of concern. The AQAA details under the heading of what we could do better, increase communication between staff, residents and relatives. Training for staff to ensure they recognise the early signs of a potential complaint and are aware of how to handle any complaints they might receive. On inspection of the complaint log, this showed that since the last key inspection the management team of the home have received 4 complaints relating to poor care practices, poor communication and cleanliness of the home. Records evidenced the specific nature of the complaint, details of any investigation (where appropriate) and action to be taken. Following the inspection, we were made aware of another Care Homes for Older People Page 21 of 39 Evidence: complaint from a relative in relation to care practices/cleanliness of the home. The complainant has made the management team of the home aware of the issues and is awaiting a formal response from Southern Cross Healthcare. It was positive to note that the management of the home had received several compliments and these included, how much we appreciate the care, support and assistance provided at Sycamore Court both to my [relative] and ourselves as a family and thank you for the care and support given to my mother. Since the last key inspection there has been one safeguarding referral and this was referred by the Commission for Social Care Inspection to Essex Safeguarding Team. No actions were taken by the safeguarding team. Staff spoken with as part of this inspection demonstrated and awareness and understanding of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge of the shift and/or the manager. The training matrix provided by the deputy manager, showed that 25 out of 32 members of staff have received safeguarding training within the last 12 months. Care Homes for Older People Page 22 of 39 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. People live in a safe, clean and comfortable environment. Evidence: A partial tour of the premises was undertaken throughout the day of the inspection. Since the last key inspection to the home, many areas have been refurbished and redecorated e.g. communal areas have been redecorated, carpets replaced, new curtains fitted etc. The operations manager advised that carpets to the communal areas on the first floor are to be replaced within the next 4-6 weeks. The home was observed to be homely and comfortable for residents and positive comments were noted from the people who live at Sycamore Court about the home environment.A random samlple of residents bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display. Comments from relatives as detailed within internal surveys and from those forwarded to us pertaining to the home environment/cleanliness recorded, yes-much improved in recent weeks, it did go through a bad period but since the commencement of the refurbishment things seem much better and sometimes the floor needs hoovering and the bathroom is dirty. However, now you are fully staffed I am sure there will be a vast improvment. One healthcare professional spoken with during the inspection advised that there had been issues relating to the cleanliness of the home and there were days when it was shocking in both communal areas and within the Care Homes for Older People Page 23 of 39 Evidence: medical/medication storage rooms. A number of health and safety issues were noted at this inspection and these related to, medication (Co-codamol Tablets) left unattended on the seniors desk on the first floor in the afternoon, the sluice door on the first floor left unlocked and several COSHH items left within a communal bathroom on the first floor. The above is not good practice and potentially places people who live in the home at significant risk of harm. A maintenance book is available within the home and this shows areas within the home environment which require work to be undertaken. A maintenance person is employed at the home Monday to Friday for 37.5 hours per week. The training matrix details the maintenance person as having up to date training relating to fire safety, fire drills, moving and handling, COSHH (Control of Substances Hazardous to Health) and health and safety. Some gaps in training as highlighted at the key inspection remain for the kitchen assistant and some domestic staff. A random sample of safety and maintenance certificates showed that the majority of equipment in the home have been serviced and remain in date until their next examination. On inspection of the hoist certificate it was unclear as to whether or not this had been serviced by its due date. Care Homes for Older People Page 24 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples wellbeing and care needs are not protected due to low staffing levels on occasions and inadeqaute training associated with the needs of older people. Evidence: The deputy manager confirmed that staffing levels remain at 1 senior and 2 members of care staff between 08.00 a.m. and 20.00 p.m. on both the ground and first floors and 1 senior and 1 member of waking night staff between 20.00 a.m. and 08.00 a.m. each day on both the ground and first floor. In addition to the above, ancillary staff are utilised at the home (cook, kitchen assistant, administrator, laundry person and domestic) and the manager and deputy managers hours are supernumerary to the above figures. On inspection of 4 weeks staff rosters, records showed that staffing levels as detailed above have not always been maintained. We have not received any Regulation 37 notifications advising us of the staffing shortfall and measures undertaken to deploy staff to the home. On the day of the inspection, the shift throughout the day was observed to be short of one member of care staff. The deputy manager advised that she had assisted staff during part of the early shift. Additionally inspectors were advised by the deputy manager that a domestic carer was currently being trained up as a carer over the past 2 weeks and was included in the figures on the staff roster, Care Homes for Older People Page 25 of 39 Evidence: however following discussion with this person inspectors were advised that they were to work alongside a senior carer and they were not part of the exisiting roster. It was of concern that on several occasions this person was observed to be left in the lounge with several residents and not supported by the senior person in charge. The AQAA details under the heading of what we do well,we ensure the correct numbers of staff are on duty, if there is any sickness we always attempt to cover with our own staff before using the agency, as an absolute last resort, to maintain continuity for our residents and our staff rotas show that the correct numbers of staff are on duty at any given time. This did not concur with the inspectors findings. The AQAA also details under the heading of what we could do better, to increase our pool of bank staff that we would use instead of agency staff. One staff survey returned to us recorded there is usually enough staff at the care home. Residents spoken with were complimentary regarding the staff at the home and comments included, the girls are lovely, staff really work hard and are very good and staff are nice. The staff files for 5 people were examined and included records for those people newly employed since the last key inspection. The majority of records as required by regulation were available, however gaps were noted in relation to no pro-forma for the manager detailing the dates that written references were received, no proof of identity for the manager, the Criminal Record Bureau (CRB) check for the manager was after they had commenced employment and there was no record of a POVA 1st having been received prior to the commencement of their employment. Additionally there was no recent photograph for the deputy manager, no record of a CRB and their POVA 1st related to another Southern Cross Healthcare home. Skills for Care inductions were available for all newly appointed staff. The record of induction for the deputy manager related to their previous place of employment and not for Sycamore Court. We recognise that the manager did not receive an induction upon commencment of their employment at Sycamore Court and this was highlighted within the previous inspection report, however we were given assurances that the manager would receive an induction. No record of an induction was evident within their file. The AQAA details as of 22/8/2008, 11 members of staff have achieved NVQ Level 2 or above and a further 7 members of staff are currently working towards a NVQ qualification. The AQAA details under the heading of our plans for improvement in the next 12 months, we are arranging more training for our senior staff members and we would expect to see all our senior members of staff with NVQ Level 3 by the end of the year. The manager is currently undertaking the Registered Managers Award. On inspection of the training matrix and from a random sample of staff employment Care Homes for Older People Page 26 of 39 Evidence: files, records showed that the majority of staff have attained since the last inspection, training relating to core areas such as fire safety, fire drills, food hygiene, moving and handling, safeguarding and infection control. Additionally records showed that 11 people have received training relating to nutrition and 16 people have undertaken training relating to health and safety. There was little evidence to show that people working in the care home had received training relating to those conditions associated with the needs of older people. One healthcare professional spoken with at the time of the inspection advised that training relating to pressure area care, diabetes, continence etc could prove beneficial to staff working within the care home. This means that some members of staff may not have the necessary skills and competence to meet the specific care needs of those people living in Sycamore Court and this potentially places people at risk of not having all of their care needs met. Care Homes for Older People Page 27 of 39 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. Whilst there are some improvements, shortfalls identified mean that the home is not run in the best interests of the people who live there. Evidence: At the time of this site visit, the manager was not present as on annual leave. The inspection was conducted with the deputy manager and the services operations manager. All sections of the Annual Quality Assurance Assessment (AQAA) were completed and the document returned to us when requested. Information recorded was informative providing a reasonable level of information about the service, however some information was noted to not give an accurate account of the current situation within the service. Staff spoken with confirmed that much had changed since the last key inspection, to Care Homes for Older People Page 28 of 39 Evidence: try and improve the care for people living in the care home and to improve on record keeping/report writing. One relative survey forwarded to us recorded, well, I think Sycamore Court is lovely, Sonia [manager] and all the staff are wonderful and The staff are so caring if I have a concern Sonia sorts it out, I think everybody at Sycamore Court are great. It is evident from this inspection that progress has been made to address previous identified shortfalls/concerns and this is seen as positive (reviewing and updating care plans, refurbishment and redecoration within the home environment, improving the nutritional needs of people and providing an appropriate activity programme for the people living at Sycamore Court). Further development is required to ensure that care planning/risk assessing processes and procedures are improved and that every person admitted to the care home has a detailed plan of care. Additionally the staffing levels at the home need to be maintained for the numbers and needs of residents so as` to ensure their safety and wellbeing, training for those conditions associated for the needs of older people needs to be improved to ensure that staff have the skills and competence to provide care to residents and robust recruitment procedures need to be adhered to in line with regulatory requirements. The management team of the home must continue to demonstrate a proactive approach to addressing and sustaining good practice within the care home, so as to ensure residents continued safety, wellbeing and positive outcomes. We must feel assured that the progress highlighted at this inspection is sustained and improved upon. The operations manager advised inspectors that quality assurance surveys for residents, relatives and staff have been completed since the last inspection, however he was not aware of the outcomes. As already highlighted within the text of this report, an internal quality assurance survey has been undertaken and completed. Since the last inspection 1 resident and 2 relatives meetings have been undertaken. The inspector advised that only 2 relatives surveys had been returned to us. The operations manager confirmed that few relatives were attending meetings at the home. On inspection of relatives meeting minutes for May and August 2008, it was of concern that some areas were misinterpretated and misrepresented in relation to the Commission for Social Care Inspection. This relates to the manager advising relatives that CSCI had said that insufficient food was being offered. We are still fighting the report, she also mentioned that we may be having a new inspector in November.... and [name of relative] asked Sonia about the occupancy levels and Sonia responded by telling all present that we are always full up and she added on that if CSCI thought we were that bad, we wouldnt be getting any referrals by now, but our occupancy levels are just showing that even though there is room for improvment, we are a very good home. The above was discussed with the operations manager and he confirmed to both inspectors that he had picked up on the above discrepancies/factual Care Homes for Older People Page 29 of 39 Evidence: inaccuracies and discussed these with the manager. The operations manager agreed that the above could be misleading. There was evidence to show that staff meetings have been undertaken since the last key inspection. Records also showed that there are regular audits undertaken by the manager and operations manager. On inspection of a random sample of supervision records for staff, evidence showed that not all staff have received formal supervision in line with National Minimum Standards recommendations. The AQAA details under the heading of what we do well, supervisions for staff are carried out to ensure staff have enough opportunities to voice their concerns and needs, and their work performance can be monitored and discussed. This did not concur with the inspectors findings. A health and safety policy was observed within the home. Accident records for residents were inspected and showed that records were well maintained and included all necessary information. Care Homes for Older People Page 30 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15(1) Ensure there is a plan of care 11/06/2008 for all residents. This must detail individuals specific care needs and how these needs in respect of their health and welfare are to be met by staff. This requirement had not been met by the previous timescale of 30/5/08. Risk assessments must be devised for all areas of assessed risk so that potential risks to residents can be reduced so as to safeguard their health and welfare. This requirement had not been met by the previous timescale of 30/5/08. 11/06/2008 2 7 13(4) 3 9 13(2) People who use the service 31/07/2008 must be protected by having suitable arrangements in place for the control, administration and recording of medicines. This requirement had not been fully met by the previous timescale of 20/04/08. Care Homes for Older People Page 31 of 39 4 18 13(6) All staff to receive training 01/08/2008 relating to safeguarding. This will ensure that staff, have the knowledge and confidence to deal with any situations that arise and residents and others will feel assured that they will be kept safe. Not inspected on this occasion. 5 27 18(1)(a) Ensure that at all times there 12/06/2008 are suitably qualified and competent staff on duty in sufficient numbers as appropriate to meet the needs of residents. Not inspected on this occasion. 6 29 19 Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents. Previous timescale of 30/4/08 not fully met. 12/06/2008 7 30 18(1)(c) and(i) Ensure that staff working at the care home receive the appropriate training to the work they perform so as to best meet residents needs. This refers specifically to training relating to those conditions associated with the needs of older people, structured induction training and training on the safe use and handling of medication. Not inspected on this occasion. 01/09/2008 Care Homes for Older People Page 32 of 39 8 36 18(2)(a) Ensure all staff working at 01/07/2008 the care home receive, regular supervision so that they feel supported and able to undertake their job effectively. Not inspected on this occasion. Care Homes for Older People Page 33 of 39 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 1 7 15 A comprehensive plan of care 15/10/2008 detailing individuals care needs must be devised. To ensure that individual peoples care needs are met by care staff and that they feel confident to provide the appropriate care. 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 7 15 All people admitted to the care home must have a detailed plan of care. Care planning at the home must identify and be effective in meeting all residents assessed needs and be regularly updated/reviewed to reflect the most up to date information. Previous timescale of 30/5/08 not fully met. This will ensure that staff have the most up to date information so as to deliver appropriate care in line with peoples care needs. 15/10/2008 Care Homes for Older People Page 34 of 39 2 7 13 Risk assessments must be devised for all areas of assessed risk. Previous timescale of 30/5/08 not fully met. So as to ensure that risks to residents can be and are minimised to ensure their health and safety. 15/10/2008 3 8 12 The health and welfare of 15/10/2008 individual residents needs to be promoted and proactively managed. This will ensure that where people receive support, records are updated, staff have the skills to recognise when to contact healthcare professionals and to provide appropriate interventions. 4 9 13 Medicines controlled under the Misuse of Drugs Act must be stored in accordance with the Act and associated regulations. This will protect residents medication from misuse and diversion. 30/11/2008 5 9 18 All staff authorised to 30/11/2008 administer medications must be trained and assessed as competent to do so. This will ensure that staff have the skills and competence to administer medication safely to people. 6 9 13 People who use the service 31/10/2008 must be protected by having Care Homes for Older People Page 35 of 39 suitable arrangements in place for the control, administration and recording of medicines. Previous timescale of 20/4/08 and 31/7/08 not fully met. This will ensure peoples health and safety. 7 18 18 All staff must receive training relating to safeguarding. This will ensure that staff have the skills and competence to deal with any issues should they arise. 8 19 13 All staff must ensure that all 15/10/2008 parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety. This refers specifically to medication left unattended on a desk, the sluice door left unlocked and several COSHH items left within communal areas. So as to ensure peoples safety and wellbeing. 9 27 18 Sufficient staff must be on duty at all times. Previous timescale of 12/6/08 not met. 15/10/2008 30/11/2008 To ensure that the numbers and deployment of staff is appropriate to meet the Care Homes for Older People Page 36 of 39 needs of the people at Sycamore Court and to ensure their safety and wellbeing. 10 29 19 Staff working within the home must be recruited robustly and all records as required by regulation sought. Previous timescale of 30/4/08 and 12/6/08 not met. This will ensure that residents are safeguarded and protected. 11 30 18 Staff must receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people. Previous timescale of 1/9/08 not fully met. This will ensure that staff have the competence, confidence and ability to meet residents care needs. 12 36 18 Staff must receive regular supervision. Previous timescale of 1/7/08 not fully met. 15/10/2008 01/01/2009 15/10/2008 So as to ensure that staff feel supported and residents know that staff are appropriately managed. Care Homes for Older People Page 37 of 39 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 1 3 Residents and their representatives should be enabled to be part of the pre admission assessment process and this should be clearly recorded to evidence the providers processes. It is recommended that all elements of the pre admission assessment are completed so as to ensure that the home are able to meet the persons needs and staff have sufficient information. It is recommended that nutritional records for people living in the care home are completed consistently so as to ensure that their nutritional needs can be clearly audited and there is evidence to show what people have eaten/drank. Additions or changes to entries on medication records should be signed and dated by the person making the change and checked for accuracy by a second person who should also sign the record. It is recommended that the activity programme is devised in larger print and/or pictorial format so as to enable the people in the home to make an informed choice. It is recommended that the menu is devised in larger print and/or pictorial format so as to enable the people in the home to make an informed choice. Confirm in writing to us as to whether or not the hoists used within the care home have been serviced and the date this was undertaken. It is recommended that the results of the quality assurance are made available to residents, their representatives and other interested parties. 2 3 3 8 4 9 5 12 6 15 7 19 8 33 Care Homes for Older People Page 38 of 39 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 © (2008) 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. 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