Inspection on 17/08/09 for Sycamore Court

This inspection was carried out on 17th August 2009.

CQC 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamore Court 23/02/09

Sycamore Court 15/09/08

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

Similar services:

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 26/11/2009.

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 is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Love     Date: 1 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 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): 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. The weekly fees range from £453.11 to £855.71 per week. Care Homes for Older People Page 4 of 30 Over 65 39 0 2 3 0 2 2 0 0 9 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 by one inspector and lasted a total of 8 hours, with all key standards inspected. Additionally, a pharmacist inspector examined medication practices and procedures. Progress against previous requirements from the last key inspection were also inspected. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self-assessment document required by law, detailing what the home does well, what could be done better and what needs improving. As part of the process a number of records relating to people who live in the home, care staff and the general running of the home were examined. 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. In addition we left surveys for relatives, staff and other professionals to be distributed, completed and returned to us. At the time of writing this report we had received a response from 3 relatives, 2 Care Homes for Older People Page 5 of 30 members of staff and 1 healthcare professional. Where comments have been recorded these too have been incorporated within the main body of the report. As a result of concerns highlighted at the previous key inspection to the home in relation to care planning, risk assessing, meeting peoples healthcare needs and providing care in line with our enforcement pathways, a Warning Letter was sent to the registered provider on 14th April 2009 detailing the breaches of regulation to the Care Homes Regulations 2001. At the request of the registered provider we met with them on the 10th July 2009 to discuss the draft key inspection report. Upon re-examining the draft report and taking into account the issues raised, some amendments to the draft report were made, however this did not change the overall rating of the service. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Records show that where risks are identified for people, clear evidence must be in place to show how these are to be managed and minimised by staff for the safety and wellbeing of people in the home. Care Homes for Older People Page 7 of 30 When medicines are not given to people, the reason why must clearly be recorded. Where people are prescribed medicines on a when required basis, there must be clear guidance for staff on the circumstances they are used so to ensure medication is used appropriately and protect people from the possible misuse of medication. There must be adequate supplies held for the continued treatment of people and the monitoring of peoples health and welfare. The temperature of the fridges used to store medicines should be recorded using the maximim/minimum thermometers installed. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 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 30 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. People who come to live at the home can be confident that their needs will be assessed. Evidence: There is a pre admission assessment format and procedure in place, so as to enusre that the staff team are able to meet the prospective persons needs. Records showed that admissions are not made to the home until a full assessment is undertaken and where appropriate additional information has been provided from the persons placing authority and/or hospital. Records also showed that formal assessments are also completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. Two members of staff spoken with at the time of the site visit confirmed they are given sufficient information about new people admitted to Sycamore Court by the management team of the home. We looked at the care file for the newest person admitted. Records showed that a pre Care Homes for Older People Page 10 of 30 Evidence: admission assessment had been completed by the deputy manager prior to their admission. Information recorded was seen to be informative and this had been transferred to form the basis of both the draft care plan and formal care plan. We spoke with the persons relative and they advised they had visited Sycamore Court on behalf of their relative prior to them being admitted. They stated they found staff to be friendly and had been given a tour of the premises and provided with written information about the homes services and facilities. They confirmed that their member of family had settled well at Sycamore Court and that they were involved in the collation of information for the pre admission assessment. The AQAA details, We encourage potential service users to join us for a meal or attend activities before making a decision to come and live here. We assess prospective service users at a time and place of their choice. The home manager, deputy manager or team leader carry out a thorough pre admission assessment to ensure the home can meet all needs. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services and facilities provided. Care Homes for Older People Page 11 of 30 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 who live at the care home can expect to have a plan of care which identifies their care needs. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the care home. At the previous key inspection (February 2009) identified shortfalls and deficits were highlighted in relation to some aspects of the services care planning and risk assessing processes. At this key inspection improvements were noted and there was evidence to show that efforts and progress are being made by the management team of the home to develop the homes care planning systems so as to ensure that records are reflective of the persons care needs and there is clear guidance for staff as to how the persons care needs are to be met. We were advised by the management team of the home that all care plans for people living at Sycamore Court have been reviewed, rewritten and updated. In addition weekly senior/management team meetings are Care Homes for Older People Page 12 of 30 Evidence: now conducted to discuss issues raised following the doctors weekly visit to the home and the community matron also attends these meetings. We were also advised that a new recording format has been introduced to record the nutritional intake of people. As part of this site visit we looked at 4 peoples care files and each person was observed to have a plan of care. As stated above improvements were noted in relation to the general recording, with some aspects being person centred and providing a good basis to staff so as to ensure that care provided was reflective of individuals care needs. For example the care file for two people recorded them as having a poor appetite on occasions. Records showed that a plan of care was in place relating to nutrition for each person, detailing their specific care needs, personal preferences, likes and dislikes, records of weight gain and loss and evidence that where appropriate a healthcare professional had visited and provided advice and support to the care team. Newly formatted daily nutritional records were in place providing information as to what food and fluids had been offered throughout the day for each person, how much had been eaten or drunk, alternatives offered and specific instructions for staff as to how to complete the records. Records were observed to be completed well. Whilst we recognise the above improvements, further development is required in some areas. The care file for one person made reference to them displaying agitation and/or aggression towards others on occasions. Records showed that a plan of care was in place, however there was no information recorded as to the circumstances that as and when prescribed medication for their agitation and/or aggression should be given, no information recorded as to what steps should be taken if the guidelines recorded for staff should not have a positive outcome and fail to calm a situation and no information to state that the person is aggressive towards other people living in the home. A challenging behaviour record is maintained, however care needs to be taken to ensure that the daily care records and challenging behaviour record provide a consistent and clear audit trail as some entries did not tally. On inspection of both the current care file and archived care file, no risk assessment relating to this persons challenging behaviour was available. Another care file made reference to the person being immobile and spending the majority of their time in their room. The care plan relating to mobility recorded them as requiring to have their body re-postioned so as to prevent them from developing pressure sores. No information was recorded as to the frequency this should be undertaken or that turn charts were to be maintained each day to evidence staffs interventions. However the care plan relating to pressure area care recorded the person should be turned every 2 hours. A risk assessment was completed and this recorded the same instruction. A sample of turn charts over a 4 week period were Care Homes for Older People Page 13 of 30 Evidence: provided to us by the senior person on duty, however these showed that the person is not being turned as per instructions recorded on their plan of care. This potentially places the person at risk of developing pressure sores. On the day of the site visit we observed at 11.00 a.m. and 13.40 p.m. that the turn chart was last completed at 06.30 a.m. The senior member of staff confirmed that the person should be turned every 2 hours. We also looked at another persons care file in relation to elimination. While a plan of care was evident in relation to them being catheterised, risks relating to a potential number of minor and major complications associated with the above were not recorded. Records showed that people living at Sycamore Court have access to a range of healthcare professionals and services as and when required, both at the care home and within the local community. These include, District Nurse services, GP, attendance at hospital appointments, Optician, Dentist, Parkinsons Nurse, Occupational Therapist and Dietician. Of those people case tracked, professional visitors records were available depicting appointments and outcomes of visits. Staff spoken with confirmed that people would receive treatment from a healthcare professional in their own bedroom to protect their privacy and dignity. One healthcare professional spoken with stated that there have been significant improvements since the appointment of the deputy manager at Sycamore Court, ensuring that where there are concerns and/or healthcare issues to be dealt with, these are referred at the earliest opportunity. At the last key inspection (February 2009) we raised concerns that blood glucose monitoring for people with diabetes within Sycamore Court was inadequate and could result in changes in blood glucose levels for individuals not being detected at the earliest opportunity. We were advised by the managing director at a meeting with us in July 2009 that staff in residential care homes would not be permitted to undertake blood glucose monitoring, however from discussion with the community matron on the day of the site visit, they confirmed that it was their expectation that if the home admitted a person with diabetes, then there should be staff on site who can undertake blood glucose monitoring. Staff interactions with people who live at the home were observed to be much improved and positive. Where support and assistance was provided by staff in relation to individuals personal care, this was conducted with respect and sensitivity. Residents and visitors spoken with were complimentary regarding the care and support provided at Sycamore Court. Comments included, I feel my relative is well cared for and has their needs met, I feel that staff like my relative as a person and Care Homes for Older People Page 14 of 30 Evidence: are quite fond of them and the girls are OK. Staff spoken with throughout the day demonstrated a good understanding of peoples care needs and how people like to be supported. Medication is stored securely for the protection of residents. Cupboards used to store medicines are temperature controlled to ensure the quality of medicines in use. The temperatures are recorded regularly and those of the fridges used to store medicines are also recorded but only the current temperature is recorded. It is recommended that the maximum/minimum temperatures are recorded to demonstrate that the fridges are working properly. Items kept in the fridge are now dated on opening. Dedicated storage is provided for controlled drugs and these were satisfactory. The requirement made on the last inspection for the cupboard to be fixed to the wall properly, has been met. Entries made in the controlled drugs register were satisfactory. Records are made when medicines are received into the home and when they are disposed of. Records are also made when medicines are given to people and these were reasonably good with very few discrepancies. These records account for all medicines in use and demonstrate that people generally receive the medicines prescribed for them. However, the record of one persons daily medication was incomplete. Additionally a person who needed to have their blood sugar monitored regularly could not have this done as there were no test strips available for use on a number of occasions. This puts the person at risk of not receiving the correct dose of medication. Records presented to us after the pharmacist inspector completed their inspection and had left the premises showed that this persons insulin was administered each day. A person who was prescribed medication on a when required basis to control their behaviour did not have satisfactory guidance in their care plan on the circumstances the medication may be used and it could therefore be used inappropriately. When medication is omitted, the reason for this is not always recorded. We expect the home to manage this rather than make a requirement on this occasion. The home carries out regular checks on the medication records and this is good practice. The AQAA details that a monthly medication audit is carried out by the home manager or deputy manager to identify any shortfalls or deficits regarding the administration of medication. In one persons room we found some medication that was not labeled for them, the label carrying someone elses name. We expect the home to manage this rather than make a requirement on this occasion. Some people look after and take their own Care Homes for Older People Page 15 of 30 Evidence: medicines and although care plans contained some aspects of the assessed risk, they need to be expanded to include the risk to other people if they are accessible, i.e not locked away. Medication is only given to people by trained staff and the level of training and competence is of a reasonably good standard. Care Homes for Older People Page 16 of 30 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. People who live at the home can expect to receive a varied diet and to have their social care needs met. Evidence: An activities co-ordinator is employed at Sycamore Court for 35 hours per week Monday to Friday, however we were advised by them that these hours are flexible to cover weekends, evenings and special events. Of those care files examined, all had a plan of care relating to the persons social care needs and a Map of Life is completed detailing their personal preferences, likes and dislikes and those people important to them in their life. A copy of the weeks activity programme was observed to be displayed on both the ground and first floor noticeboards and an activity folder is available within the main reception area. On inspection of 4 weeks activity programme, records showed that people living at Sycamore Court are given the opportunity to participate within a varied schedule of activities. Records showed that people can participate in listening to music, Indian head massage, reminiscence, music quiz, film afternoon with popcorn, sherry morning, 1-1 visits for people who spend the majority of their time in the comfort of their room, keep fit, coffee morning, religious observance, garden projects and visits by external Care Homes for Older People Page 17 of 30 Evidence: entertainers. The AQAA details that the activities programme is compiled with input from people living at the home and at the request of service users, external entertainers now visit the home twice monthly. This was confirmed from evidence of the past 4 weeks activity programme. Photographs of recent activities are displayed around the home. A monthly newsletter is produced and this is available for both people living at the home and their relatives and/or representatives. This provides information relating to individuals special birthday celebrations, special or themed activities and/or events (Strawberry Fair/Race Night) and general news about Sycamore Court. The newsletter for August 2009 details that over the past 2 months networks with local sister homes in the area have taken place and this has included people attending a tea dance, lunch and enjoying an external entertainer. There remains an open visiting policy whereby visitors to the home can visit at any reasonable time. People spoken with confirmed that their visitors are made to feel welcome and that they can see them in private if they so choose. People spoken with confirmed that they do have some control over their lives and are enabled to make choices and decisions where able. This refers specifically to choosing whether or not they spend time in their own room or in the main lounge, whether or not they join in activities or pursue their own interests, times of getting up and going to bed and where they choose to eat their meals. The lunchtime meal was observed within the ground floor dining room. A menu depicting the meals available for the day were placed on each table. There remains a rolling 4 week menu and this showed that people who live at the home receive a varied diet. Tables were seen to be attractively laid with tablecloths, condiments, glasses, vase of flowers and serviettes. The dining experience for people at Sycamore Court was observed to be positive and where people required assistance, this was provided by staff in a respectful and sensitive manner. The atmosphere in the dining room was calm and staff were clear about their roles. Three people were observed to make positive comments about the quality of the meals provided and these included, I like fish pie, its nice isnt it, The food is lovely and That was good. Care Homes for Older People Page 18 of 30 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. People can expect their concerns to be listened to and acted upon and to be protected from harm and abuse. Evidence: There is an appropriate complaints policy and procedure in place at Sycamore Court and further information is recorded within the Service Users Guide. People spoken with confirmed they were confident to raise concerns and/or issues and knew who to speak to. On inspection of the complaint log there have been no complaints since the last key inspection. The AQAA details that the manager holds a surgery once a week during the evening so as to meet with family members and/or other interested parties. Records of compliments were available and comments included, I just wanted to thank you all, for looking after my relative. Really appreciated the peace of mind you gave me. I was able to leave my relative in your kind hands and not to worry too much about them. Appropriate safeguarding policies and procedures were in place. Two members of staff spoken with were able to demonstrate a good understanding and awareness of safeguarding procedures. On inspection of the staff training matrix, records showed that all staff have received up to date training relating to safeguarding and 20 members of staff have received training relating to dealing with aggression and/or challenging behaviour. Care Homes for Older People Page 19 of 30 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 who live at Sycamore Court know that the home environment will be safe, homely and comfortable to meet their needs. Evidence: A partial tour of the premises was undertaken. A random sample of peoples bedrooms were inspected and all were seen to be personalised and individualised. People spoken with continue to be happy with their personal space and find the home environment to be comfortable for their needs. The internal refurbishment of the home is complete and new fixtures and fittings are in place. The garden and patio area have been revamped so as to entice people to use the space more. The home was observed to be clean, tidy and odour free on the day of the site visit. One health and safety issue was highlighted during a tour of the premises and this related to the cleaners cupboard on the first floor being unlocked and COSHH (Control of Substances Hazardous to Health) items easily accessible. This was highlighted at the previous inspection to the home and poses a potential risk to people. A maintenance person is employed at the home Monday to Friday. The staff training matrix showed that the maintenance person has up to date training relating to fire safety, moving and handling, COSHH and health and safety. Records relating to the homes fire records were inspected. Records showed that there Care Homes for Older People Page 20 of 30 Evidence: is an up to date fire risk assessment for the premises, fire alarms and fire doors are checked each week and where there are discrepancies pertaining to the latter a record of corrective action undertaken is recorded. The homes emergency lighting is tested each month and regular fire drills are undertaken. Care Homes for Older People Page 21 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can expect to be cared for by a stable staff team, who are robustly recruited and who have received training. Evidence: The manager confirmed that staffing levels at the home remain at 1 senior member of staff and 2 members of care staff between 08.00 a.m. and 20.00 p.m. and 1 senior member of staff and 1 member of care staff between 20.00 p.m. and 08.00 a.m. each day. The managers hours are supernumerary to the above figures, the deputy manager receives 1 supernumerary shift per week and an administrator is employed Monday to Friday between 10.00 a.m. to 18.00 p.m. In addition to the above, ancillary staff are employed and these include cooks, housekeepers and domestic staff. On inspection of 4 weeks staff rosters, records show that the above figures have been maintained. On the day of the site visit the roster and actual staff on duty were observed to be correct. The AQAA details, The correct number of staff are on duty at all times. In the case of sickness the quota is made up with staff from other homes in the group in order to maintain continuity of standards of care. No agency staff have been used since March 2009. The AQAA details that a pool of bank staff needs to be increased so as to ensure that the use of agency staff is kept to a minimum. The manager advised that there is now a settled staff team and there is a low turnover of staff. Care Homes for Older People Page 22 of 30 Evidence: The AQAA details that since the last key inspection in February 2009, 4 new care assistants and a deputy manager have been newly recruited. As part of this site visit the staff files for 3 people newly employed were examined. Records show that robust recruitment procedures are in place so as to ensure that people are safeguarded. Records showed that each person received an comprehensive induction and this was confirmed by 2 people spoken with. NVQ information provided to us, show that 10 staff have NVQ Level 2, 1 member of staff has NVQ Level 3, 2 staff are currently undertaking NVQ Level 2 and 5 staff are currently undertaking NVQ Level 3. On inspection of the training matrix, records show that since the last key inspection, staff have received training in both core and specialist subject areas. These refer specifically to fire safety, fire drills, food hygiene, moving and handling, COSHH, health and safety, safeguarding, infection control, nutrition, pressure area care, customer care, dementia awareness and bed rail safety. Staff spoken with were able to demonstrate a reasonable awareness of the care needs of individual people case tracked. Care Homes for Older People Page 23 of 30 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. Residents can expect to benefit from developing management systems that will promote positive outcomes for the people who live at Sycamore Court. Evidence: The manager has many years experience in caring for older people and has been managing Sycamore Court since November 2007. The manager has completed the Registered Managers Award. As a result of concerns expressed by us in relation to the management of the home, following the last key inspection, the manager has withdrawn their application at this time to be formally registered with the Care Quality Commission. From our observations, discussions with the manager and operations director, we were made aware that the manager continues to be supported by the organisation to manage the care home. On the day of inspection a trainer was present and they were undertaking supervision sessions with some members of staff. We were advised that in addition to their role they are providing training for staff (Infection control, health Care Homes for Older People Page 24 of 30 Evidence: and safety, pressure area care, customer care and dementia awareness). The manager advised us that she continues to be mentored by another home manager from within the organisation, the operations manager visits the home twice weekly and the operations director visits the home once weekly. We enquired as to the length of time that support would be provided to the manager at this level and were told that this would remain until the organisation felt confident that the improvements made would be sustained and/or maintained. Evidence from this inspection show that progress has been made to address previous identified shortfalls and concerns. While improvements were noted in relation to some aspects of care planning, meeting the healthcare needs of people, sufficient numbers of staff being on duty, staff training and staff supervision, further development is required in relation to risk assessments, completion of turn charts and some aspects of medication practices and procedures. The management team of the home must ensure that progress achieved at this site visit, is maintained and sustained for the wellbeing of the people who live at Sycamore Court. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was informative providing a reasonable level of information about the service. The organisation have several ways of monitoring the quality of the service provided. These include, monthly Regulation 26 visits, monthly audits undertaken by the manager and daily audits. We were advised that a new outcome audit has been introduced over the past 4 months by the organisation and this is based on the National Minimum Standards and Care Homes Regulations for Older People. The manager also advised that a new care plan audit has been devised and is due to be implemented. Records were available to show that staff meetings and resident/relative meetings are regularly undertaken. We were advised by the manager that the views of people who live at the care home, their relatives, staff and other stakeholders are sought about the quality of the service provided at Sycamore Court. Evidence showed that the views of people who live at the home and their relatives were gathered in June 2009 and in August 2009 staff views were sought. Positive comments were recorded and these included, We would just like to thank you for all the care you gave to our relative and I am extremely happy about the care my relative receives at Sycamore Court. They are happy and contented and constantly state how lucky they are to be there. A health and safety policy was observed within the home. The majority of staff who Care Homes for Older People Page 25 of 30 Evidence: work at the care home had received health and safety training. Care Homes for Older People Page 26 of 30 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 13 Risk assessments must be devised for all areas of assessed risk. Risk assessments must be reviewed and updated to reflect changes to peoples needs. Previous timescale of 30/5/08, 15/10/08 and 1/4/09 not fully met. So as to ensure that risks to residents can be and are minimised to ensure their health and safety. 06/11/2009 Care Homes for Older People Page 27 of 30 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 9 14 Where people are prescribed 30/10/2009 medication on a when required basis there must be clear guidelines for their use. This will ensure medication is used appropriately and protect people from the possible misuse of medication. 2 9 13 There must be adequate 15/10/2009 supplies of medicines and related substances held for the continued treatment of people and the monitoring of peoples health and welfare. This will ensure people can receive the treatment prescribed. Care Homes for Older People Page 28 of 30 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 8 Where turn charts are in place, these should be completed in line with the persons care needs so as to evidence staffs interventions. The temperature of the fridges used to store medicines should be recorded as the maximum and minimum reached, the current temperature and should then be reset for the next recording period. This will ensure the quality of medicines stored. 2 9 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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