Inspection on 17/03/08 for Sycamore Court

This inspection was carried out on 17th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sycamore Court 17/08/09

Sycamore Court 23/02/09

Sycamore Court 15/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sycamore Court Magpie Lane Little Warley Brentwood Essex CM13 3DT Lead Inspector Michelle Love Unannounced Inspection 07:50 17 , 19th March and 4th April 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Court Address Magpie Lane Little Warley Brentwood Essex CM13 3DT 01277 261680 01277 202028 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare (West) Limited Vacant Post Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2007 Brief Description of the Service: 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 homes weekly fees range from £434.79 to £817.32 for a private room. Additional charges are provided to residents relating to hairdressing, personal toiletries, newspapers and magazines, chiropody and sweets. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection. The visit took place over three days and lasted a total of 24 hours, with all but one of the key standards inspected. Additionally, the manager’s 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, 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 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 the 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. It is disappointing that at the time of writing this report only one staff survey had been completed and six relatives surveys received. However, of those received, comments are highlighted within the main text of the report. The manager, deputy manager and other members of the staff team assisted the inspector on all three days of the inspection. Feedback on the inspection findings were given throughout and summarised at the end of each day. The opportunity for discussion and/or clarification was given. The operations manager from Southern Cross Healthcare was present for part of the first and third day’s inspection. The main text of the report highlights a number of shortfalls, which have been emphasised at previous inspections to Sycamore Court. As a result of concerns relating to care planning/risk assessing, health and welfare of residents/poor nutrition, poor staff recruitment procedures and poor staff supervision, a Code B notice of the Police and Criminal Evidence Act 1984 was issued and a number of documents relating to the above issues were photocopied and provided to the Commission for Social Care Inspection. Should shortfalls as identified within the main text of this report not be addressed by the registered proprietors, the Commission for Social Care Inspection may consider taking legal action. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Further development is required to ensure that care planning records are more detailed, recording staff interventions and actual delivery of care to individual residents. The management of medication practices and procedures at Sycamore Court needs to improve so as to ensure residents safety and wellbeing. The deployment of staff at the home needs to be reviewed so as to make sure that all residents needs are met at all times. Routines within the home need to be improved so that these are resident led rather than staff orientated. 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 resident’s needs and to deliver good care. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 7 The home environment needs to be furnished and equipped to meet the needs of those people who live at Sycamore Court. The management of the home must ensure there is a clear sense of direction, which demonstrates and ensures an effective understanding of people’s needs and robust operational systems. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an appropriate system in place to ensure that residents are assessed prior to admission and that the home can meet the needs of prospective residents. People have the information they need to make an informed choice about where to live and that Sycamore Court is the home of their choosing. EVIDENCE: A copy of the Statement of Purpose and Service Users Guide is available in the main reception area of the home and since the last key inspection both documents had been revised to reflect recent changes and include a copy of the last key inspection report. It was positive to note that on inspection of a random sample of resident’s rooms, a copy of the Service User Guide was readily available. A copy of both documents was provided to the inspector and these were examined following the inspection. On inspection of both documents, care Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 10 must be taken by the management of the home to ensure that information recorded, accurately reflects services and actual care provided to those people who reside at Sycamore Court. The inspection highlighted that some elements contained within both documents does not concur with what happens in practice. Examples to evidence this are highlighted throughout the main text of the report. Two care files for the newest resident’s admitted to the care home were examined and detailed that the management team of the home completed a pre admission assessment prior to admission for both people, so as to ensure that they are able to meet the prospective resident’s needs. The manager was advised to ensure, that as part of good practice procedures, where a prospective resident is admitted on the same day as the pre admission assessment undertaken, the rationale for the decision is clearly recorded. As part of the assessment process, formal assessments were completed relating to dependency, moving and handling, pressure area care, nutrition and continence. The Annual Quality Assurance Assessment confirms, “before a service user comes in to the home we encourage the service user and family to come a long and have a look at the service we deliver. We carry out a preassessment to ensure we can meet the service users needs”. In addition to the formal assessment process, additional information had been provided, by the individual resident’s placing authority and/or hospital. No information was available to indicate that either resident and/or their representative were given the opportunity to visit the care home prior to admission. One resident was asked to confirm as to whether or not they and/or their representative had been afforded the opportunity for a trial visit to the care home, however the resident was unable to advise as they could not remember if this had happened. No evidence was available to indicate that the management team at the home had confirmed in writing to the resident and/or representative that they could meet the individual person’s care needs or that the care home was appropriate. The Statement of Purpose details that the prospective resident and/or their representative will be formally written to. This was discussed with both the manager and operations manager at the time of feedback. The care home does not provide intermediate care. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents can be sure they have an individual plan of care in place, however significant shortfalls in care planning, risk assessing and medication practices were highlighted which could have an adverse affect on outcomes for residents and their wellbeing. EVIDENCE: There is a formal care planning system in place to identify the care needs of individual residents and to specify how these are to be met by care staff. The care planning system remains comprehensive and makes reference to an individual’s health, emotional and social care needs. Additionally it includes formal assessments relating to nutrition, pressure area care, continence, falls, dependency levels and moving and handling. As part of this inspection 2 care files were examined in full and a further 6 care files were partially examined. Care records show that further development of the care planning and risk assessment process is required. Staff, must ensure Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 12 that individual resident’s needs are fully recorded, and include the interventions required so as to ensure the appropriate delivery of care. Care records must be regularly reviewed to reflect individual resident’s changed needs and how this affects their daily life. Particular attention must be afforded to those people who are at nutritional risk and who regularly refuse their prescribed medication. Medication Administration Records (MAR) for several people indicated that they refuse some of their prescribed medication on a regular basis. Of those care files examined it was positive to note that a care plan relating to their medication had been devised, detailing medication prescribed and its possible side effects. However, where MAR records recorded that medication was refused by the resident, this was not highlighted within the person’s care plan and no risk assessment had been devised identifying how the risk was to be minimised. There was no evidence this was being monitored by staff, or that appropriate advice had been sought from a healthcare professional. The manager, when questioned, advised the inspector that she was unaware of the issue and one senior member of staff confirmed to both the manager and the inspector that although the GP to the home visits regularly, the above issue had not been discussed or brought to their attention. A random sample of records was examined in relation to individual’s nutrition. Although records highlighted in some cases that they had a poor appetite, were underweight and in some instances at high nutritional risk, there was little information recorded detailing the steps to be undertaken by staff so as to provide appropriate interventions. The care plan for one resident detailed that nutritional intake charts were to be completed on a daily basis and that they were to receive encouragement to eat and drink. It was concerning that no nutritional intake charts were completed/available on both days of the inspection and that following discussion with the manager on the first day, these remained not devised or implemented. Nutritional records for other people were inconsistently completed and the filing system observed to be disorganised. Additionally it was of concern that following admittance to the care home, the home’s chef only appeared aware of the resident’s poor food intake and personal preferences. This was not updated and reflected within the care plan evaluation record. The malnutrition screening tool for one resident detailed that over a 4-5 month period that they had lost over 10KG. Although it is recognised that during this period they were admitted to hospital for a short period of time, as a result of illness, and the care plan had been updated to reflect the resident’s significant weight loss (required to be weighed weekly), no evidence was available to indicate that staff were undertaking this as recorded. Care plans were not reviewed consistently and did not fully reflect the resident’s changing needs. This does not concur with the Annual Quality Assurance Assessment which details, “The care plans are evaluated each Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 13 month and updated should any care needs change”. The Statement of Purpose also states “The care plan will be reviewed in the home on at least a monthly basis”. At the time of the inspection the manager was asked as to what proactive action was being undertaken to try and improve the individual’s nutritional intake. The manager was unable to clarify and spoke to a senior member of staff. The senior on duty advised that the only advice given by the GP was to provide the resident with a milky drink at night. Following discussion with the manager, the manager confirmed that this course of action was inadequate. The care plan/record of professional visits did not reflect the advice given by the healthcare professional. We also recognise that during the month of January 08, there was an outbreak of influenza at the home however recording/records remain poorly completed and did not provide sufficient evidence as to staff’s interventions and/or care required. The manager was also advised to ensure that where information is recorded within the pre admission assessment, this is transferred to the person’s care plan and where appropriate a risk assessment is devised. Of those care plans inspected there was little evidence to suggest that these had been devised with the resident and/or their representative. One relatives survey made reference to them having sight of their relatives care plan however it is of concern that they felt unable to agree the contents. The survey recorded “I refused to sign a new care plan as I was so unhappy with the level of care”. The Annual Quality Assurance Assessment details, “The service user and relative are involved in implementation of the care plan, and agree and sign if able to do so”. The Statement of Purpose also made reference to residents and/or their representative being actively encouraged to participate within the care planning process. It was positive to see that, in some cases, formal reviews had been undertaken with individuals placing authority and family involvement. Records showed that residents have access to a range of healthcare professional services such as chiropody, optician, District Nurse services and GP as and when required. Staff advised that the relationship with the GP is positive and that they visit the home once weekly for a formal surgery. Not all members of staff were observed to treat individual residents with respect and dignity. One resident was overheard, on the second day of inspection, to state to a member of staff that they needed to see a doctor. The member of staff was observed to dismiss the resident’s request and to walk away without answering the resident or providing reassurance. Additionally a healthcare professional was overheard to state to a resident that they were going to redress the person’s dressing on their leg and that this task would be undertaken within the lounge area. The inspector did not hear the Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 14 resident being given a choice as to the location of their examination/treatment and other residents were not consulted or asked if they minded. Of those relatives surveys returned, mixed comments were recorded pertaining to relatives being provided with sufficient information about their member of family. Comments ranged from “regular meetings are arranged on a quarterly basis, between the care home management and residents families”, “I am kept up to date with events” to “information only forthcoming in times of extremis, I had to constantly approach and ask searching questions about my relatives health and wellbeing” and “the level of communication fluctuates”. One relative spoken to on the third day of inspection, confirmed to the inspector that communication between themselves and staff in relation to their member of family was variable and caused frustration and anxiety on occasions. The management team of the home must consider ways of ensuring that good communication systems are in place to enable information sharing. Deployment of staff on both days of inspection was observed to be inconsistent. This refers specifically to the lounge area on the first floor being staffed so that residents felt supported however there were periods of the day on the ground floor when residents were left unattended in the lounge area and without obvious support from care staff. This potentially places residents at risk and could affect their wellbeing. The training matrix (statistic sheet) details that 80 of staff have received training relating to care planning. It is unclear from the matrix as to who has actually received this training, as this is not recorded for individual staff. The Annual Quality Assurance Assessment under the heading of `our plans for improvement in the next 12 months` details, “For all staff including care assistants to be trained in care planning”. The majority of medication is managed through a monitored dosage system (blister pack). Administration of medication to residents was observed during the inspection and this was seen to be satisfactory. Storage systems within the home were appropriate, however both medication rooms were noted to be hot despite air conditioning units being available and records detailed that the room temperature was consistently above 25° Centigrade. The manager was advised that this is too hot and some medications may deteriorate and lose their properties as a result of the environmental conditions. This was highlighted at the last key inspection to the home and remains outstanding. Shortfalls were identified in relation to the Medication Administration Record (MAR) record for three people detailing that some of their medication was not administered, as they were asleep. No evidence was available to indicate that their medication was offered and/or administered later during the morning/when they had woken up or that their medication had been Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 15 administered before they retired to bed. This is poor practice and means that some people who do not receive their prescribed medication could potentially have their wellbeing and/or safety compromised. The handwritten MAR sheets were not always double signed by staff to evidence information recorded was accurate. Additionally there was no record of some medicines having been given to the resident when they were due, as the entries on the MAR chart had been left blank. Where the prescriber’s instructions state 1 or 2 tablets to be administered, the actual dose administered was not always recorded. Inconsistencies on the MAR record were observed for those people who require PRN (when required) medication e.g. some staff were recording using a code as specified on the MAR record and other staff were leaving the record blank. During feedback, the operations manager advised that this issue was being discussed within the organisation so as to obtain a consistent approach. Storage facilities and records were inspected for controlled drug medication held securely at the care home. Discussion took place with one senior member of staff in relation to the storage of three injection medications, as there was a query by the member of staff as to the correct storage procedures. Following the inspection advice was sought from a specialist pharmacist inspector and this has been forwarded in writing to the care home for them to action. Records relating to controlled drug medication were observed to correspond with actual medication stored. On the second day of inspection, the manager was questioned as to what systems within the home were in place to ensure safe medication practices and procedures for residents and to address the above, identified shortfalls. The manager advised that weekly monitoring is to be undertaken by herself and/or the deputy manager, once appropriate forms for recording have been designed and implemented and senior staff who administer medication are to receive further training and development. This does not concur with the Annual Quality Assurance Assessment which states under the heading of `what we do well`, “Audit of MAR sheets at handover, and daily by the manager”. Handover by senior staff was witnessed by the inspector on the first day of inspection, however no audit of MAR records was witnessed. The manager produced the findings of a medication audit, which was conducted in October 2007 by a senior member of care staff. Evidence showed there were discrepancies between the quantity of medication received, quantity administered and the actual quantity of medication remaining. No further medication audits as described above were available as these could not be located at the time of the inspection. A full medication audit was conducted by the Operations Manager on 29/1/08 and a further audit conducted by the deputy manager on 14/3/08. It is of concern that on both occasions, findings concluded that correct procedures were not being followed for the administration of medication, refusal of medication by residents not being Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 16 recorded accurately and residents GP not informed when a resident persistently refuses their medication. It was of concern and disappointing to note that although the management team of the home were aware of the deficits, no measures had been put in place to address the failing. Training records indicated that all but one member of staff who is named as administering medication to residents had attained up to date medication training. Not all members of staff had evidence of a medication competency assessment within their personnel file. The Annual Quality Assurance Assessment under the heading of `What we could do Better` details, “3 monthly competency will be carried out on all senior care staff for medication”. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in the activities programme at the home, means that some residents do not have their social care needs met. Not all residents have their nutritional needs met and this means that some residents do not receive a varied and balanced diet, which could affect their health and wellbeing. EVIDENCE: At the time of the inspection, a new activities co-ordinator had been in post for two weeks and is employed for 30 hours per week, Monday to Friday. Evidence from their personnel file indicated that they have completed training from NAPA (National Association for Providers of Activities for Older People) in 2007 and training in dementia care. Evidence was available that the previous activities co-ordinator had compiled a rolling four weekly activity programme comprising of dominoes, ball games, scrabble, bingo, arts and crafts, film afternoon, reminiscence, gently exercise, shopping cart, `your choice` and occasional external entertainers. Two residents confirmed that they receive a daily newspaper. Additionally the hairdresser visits once weekly and there is a monthly church service held at Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 18 the care home. The schedule, was observed to be displayed on both the ground and first floors, however the newly employed activity co-ordinator advised the inspector that bingo is the only activity being regularly provided in line with the programme. No revised activities programme had been devised and/or implemented at the time of the inspection. There was little evidence to indicate that residents were actively encouraged to access the local community. A programme of forthcoming events had been designed by the previous activities co-ordinator and detailed resident’s birthdays and dates of future residents meetings. Comments from residents relating to activities provided at the care home were mixed. One resident stated that they wished there was more opportunity to access the community and to have the opportunity to have a cup of tea and cake. Another resident advised that they were happy not to participate within the activity programme and enjoyed time spent in their room, watching television and reading the newspaper/magazines. Comments from relatives surveys were at variance and recorded, “Generally a programme of activities and outing is provided by a specialist activity organiser”, “Activities are well organised for the residents to participate in” to “Residents were isolated from the community” and “There is a lack of appropriate activities”. Two newsletters were displayed for December 2007 and ‘Looking Back Over 2007’. It is hoped for this to continue periodically. On inspection of a random sample of resident’s care files, not all were observed to have their social care needs/personal preferences, likes and dislikes documented. Both the manager and activity co-ordinator advised the inspector that `Maps of Life` and activity profiles are to be completed with all residents and where appropriate to include involvement from their relative/representative. Prior to the appointment of the new activity co-ordinator, daily information records showing activities undertaken were completed and seen to contain good information. The new activity co-ordinator advised that she has been unable to complete these since her appointment as “these have run out”. This is poor practice and needs to be addressed with immediate effect, as it is important that the management team of the home are able to clearly demonstrate how it meets the needs of existing residents. On the first day of inspection (St Patrick’s Day) a notice was placed on the notice-board on both the ground and first floor advertising the activity of the day (making Baileys drink). The manager was advised to consider enlarging future activity programmes/adverts so that it is easier for residents to see and to enable them to make an informed choice. The above activity was undertaken in the afternoon and although some residents were observed to enjoy this activity, little other entertainment or stimulation had been provided throughout the day. During the morning the activities co-ordinator was Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 19 observed to sit within the ground floor lounge area. When questioned as to what activity was planned, she stated that they were listening to an Irish CD. At the same time as the CD played the television was observed to be on and limited verbal interaction was taking place between residents and staff. Interaction between staff and residents was inconsistent within both the ground and first floors. Rapport and interaction between staff and residents within the first floor was observed to be more interactive and positive. However, the lounge area on the ground floor was left unsupervised for periods of time and when staff, were evident, they were observed not to interact with residents. The most appropriate interaction between staff and residents observed during the inspection was by the chef and the kitchen assistant. Residents were observed to smile and to become animated during these engagements. Of those residents spoken with, all advised that they are able to exercise choice e.g. rise/retire to bed when they choose and can have meals in their room or eat in the dining room. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. The Annual Quality Assurance Assessment details that the manager has an `open door policy` and family and friends of residents are encouraged to visit the care home and to discuss any areas of concern. On both days of the inspection no menu displayed, detailing the choice of meals available to residents for the day. The manager advised the inspector that a new system of nutritionally balanced meals had only just been introduced on 17/3/08 (NUTMEG) and as yet no menu’s had been devised. This is disappointing as following discussions with both residents and care staff neither was able to confirm what choices were available for lunch/tea. The delivery of the lunchtime meal was observed within the ground floor dining room. Dining tables were attractively laid with tablecloths, small vases of flowers, cutlery, serviettes and a range of condiments. Residents were offered a choice of juice (lemon/orange) with their lunchtime meal. It was disappointing that jugs of juice were not placed on the table so as to enable where appropriate, individual residents to help themselves and to promote self-esteem and independence. There was a choice of two main meals and dessert for residents. In addition to the two choices, alternatives were also available e.g. sandwich, soup or omelette. Meals provided to residents were seen to be plentiful and attractively presented. Those residents who require a soft diet/pureed meal also received an attractively presented plate of food, with each item of food portioned separately. One resident was observed to have specialist equipment available e.g. plate guard/specially designed cutlery. At the time of the lunchtime meal, 12 residents were observed to be seated in the dining area and staff advised Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 20 the inspector that a small number of residents choose to have their meal in the privacy of their room (3 of whom require assistance from staff to eat their meal). Comments from residents, pertaining to food provided, were positive. Comments provided to the inspector included “Oh I have no complaints”, “the meat is so tender it melts in your mouth”, “the food is good, I enjoy my food” and “its lovely”. One resident was observed to receive their meal at 12.35 p.m. The resident was noted to not attempt to eat their meal and to push the plate away on two occasions, stating “no more”. Although staff, were intermittently present within the dining area, none of the three members of staff on duty noted that the resident had not commenced eating their meal. No assistance was given to the resident for a further 15 minutes, until the kitchen assistant noted that the resident had not eaten their meal. The kitchen assistant provided assistance to the resident and they were observed to only eat a small amount of food. No alternative to the menu was offered to this resident, however another resident was offered an alternative when they complained that they did not want their original choice. The care plan for the resident who pushed their meal away, recorded them as having a poor appetite and requiring a lot of encouragement to eat, for their weight to be monitored monthly and for daily nutritional records to be completed. Evidence indicated that the person’s weight was not recorded in line with their care plan and nutritional records not completed daily. The risk assessment in place only made reference to the person being at risk of choking and not that they had a poor appetite and required assistance. Additionally, after the above observation, the inspector spoke to the senior in charge and asked as to why no assistance had been provided to the resident. The inspector was told that the resident can eat without assistance when she chooses, however this did not concur with the findings and observation on the day of inspection. During the morning of both days inspection, the inspector observed that no jugs of juice/water were available within the ground floor lounge area for residents to access from the completion of breakfast to late morning (11.25 a.m./12.00 midday). The manager was advised at the time of the inspection and liquid refreshment was provided. This concurs with comments made by a relative at a relatives meeting at Sycamore Court on 6/12/07. It was of concern that during the lunchtime meal, the dining area was often left unsupported by care staff. The manager was advised that this potentially places people at risk and could affect their wellbeing. The Annual Quality Assurance Assessment details that over the next 12 months it is hoped to turn two small lounges into an activity/family room, whereby visitors can have a meal with their member of family and enjoy private time together. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there is an appropriate complaints procedure and system for logging complaints, people who use the service do not always feel their concerns are taken seriously and acted upon. EVIDENCE: The home has a corporate complaints policy and procedure, which is detailed within the Statement of Purpose and Service Users Guide and displayed within the main reception area. It is evident that relatives and others are aware of how to make a complaint and the complaint process. The manager advised that she has commenced a surgery, once weekly, to give relatives an opportunity to discuss any issues and/or areas of concern. The manager advised on the third day of inspection that to date no formal surgery has taken place as no appointments had been scheduled and/or requested from relatives/other interested parties. Prior to the inspection the Commission for Social Care Inspection received a number of concerns and complaints from relatives in relation to inadequate staffing levels, poor hygiene standards within the home environment, poor standards of care for their member of family and concerns that the passenger Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 22 lift was, on occasions, out of order. Relatives spoken with advised the inspector that concerns relating to the above had been highlighted over a period of 1216 months to the registered provider, however as little had been done to rectify the issues. They said that they lacked confidence in the provider’s ability to remedy the areas of concern and felt that they had no option but to contact the Commission. One relatives survey recorded “Several issues raised with the home do not seem to have been dealt with or with appropriate concern”. Complaint records were requested from the manager, however these only went as far back as December 2007. The manager advised that she was unaware as to where the records were, however she believed these to have been archived. On inspection of complaint records since December 2007, these were noted to include details of the specific nature of complaint, details of any investigation (where appropriate) and action to be taken. The specific nature of the complaints inspected, concurred with those issues as detailed above. The Commission is concerned that action by the registered provider to address the areas of concern as detailed above, has been slow and ineffectual to date. Records indicate that a relatives meeting was undertaken in December 2007, where, concerns were raised by relatives with assurances given by the management of the home that issues would be rectified. The newly appointed operations manager who was present for part of this inspection advised the inspector that stringent efforts are being made by the registered provider to address the above issues and to build bridges with relatives and to restore faith in both the management of the home and the organisation. A meeting was held with relatives on 10/3/08 and this confirmed, “the high standard required by Southern Cross Healthcare is not yet being met”. No safeguarding issues have been highlighted since the last key inspection. Policies and procedures relating to safeguarding are readily available within the home. Staff spoken with demonstrated an awareness and basic understanding of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge of the shift. The training matrix detailed that only 63 of staff have attained training relating to Safeguarding. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical environment does not always meet the specialist needs of the people who use the service and maintenance tends to be reactive rather than proactive. EVIDENCE: A partial tour of the premises was undertaken at various times, over the twoday inspection. On both days the home was observed to be odour free, however areas of the home remain tired and in need of a clean and refurbishment. Several toilets were noted to require de-scaling as they were stained. Two health and safety issues were highlighted on the second day of inspection pertaining to the ground floor sluice room being easily accessible. Additionally a number of COSHH (Control of Substances Hazardous to Health) items were Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 24 also within easy reach. The manager was advised at the time of the inspection and confirmed that she was aware of the poor lock on the sluice door, however no action had been taken to make the room safe and secure. The manager further stated that a keypad lock is too be fitted. On the first floor the disabled toilet floor was observed to have been cleaned, however when walked upon this was still wet and slippery and could cause a health and safety risk to residents and others. No sign to indicate that the floor had been cleaned was on display. The senior in charge was advised of the issue. A random sample of resident’s bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display e.g. ornaments, photographs etc. Residents spoken with confirmed that they liked their personal space and were keen to show the inspector their private telephones and/or access to satellite television. Despite, there having been domestic staff on duty during the day, on inspection of a number of communal toilets/bathrooms, no liquid soap was available. The manager was advised that this is not acceptable as there could be a risk of infection/cross infection to residents and others. Concerns had in recent months been expressed by relatives with regards to the lack of domestic staff in the home. The manager advised that this issue is being rectified and a monitoring system is to be implemented to ensure that the home’s cleanliness is improved upon. Correspondence dated 28/1/08 from the previous operations manager to a concerned relative confirmed that the registered provider had experienced difficulties in the recruitment of domestic staff, however a housekeeper and domestic assistant had been recently recruited so as to ensure that the cleanliness of the home would be improved and maintained. As stated previously, the Commission for Social Care Inspection, had been notified by relatives of their concerns, relating to the care home environment (cleanliness of the home and non-operational equipment/passenger lift and insufficient hot water within the care home/kitchen). Evidence concurs with the above as at the time of the inspection, the passenger lift was out of order. Both the manager and operations manager advised the inspector that engineers visited the home on the day of the fault, however this could not be fixed and a part had to be ordered. Confirmation was received from the operations manager that the passenger lift became fully operational as of 28/3/08. However, on the third day of inspection it was observed that the passenger lift was not operational. The manager confirmed when questioned that the lift had only been in working order for approximately one hour on 28/3/08 before it broke down. Records indicated on two occasions that this had a detrimental impact on residents, resulting in two residents not being able to attend scheduled hospital appointments (one resident was visited by a healthcare professional in the home as a result of the above). Additionally, one relative advised the inspector that their member of family was unable to return Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 25 to their room on the first floor following a short stay in hospital, as the lift was not working and had to stay in a room on the ground floor. On the second day of inspection hot water was observed to be only luke warm from a random sample of resident’s wash hand basins. The record of hot water temperatures evidenced that these fall between 36° and 41° Centigrade. Kitchen (hot water) temperatures were inconsistently recorded and of records seen these fell between 43° and 53° Centigrade. The hot water temperatures in the kitchen are deemed too low and do not ensure appropriate systems are in place to control the spread of infection. The operations manager has provided the Commission for Social Care Inspection with a copy of Sycamore Court’s decoration and refurbishment plan. This is seen as positive and commenced on 2/3/08 and is due for completion by 1/5/08. This includes redecoration of all communal areas, individual resident’s bedrooms to be redecorated, carpets and curtains to be replaced and existing furniture to be assessed and where appropriate to be replaced. With regards to issues highlighted at the previous inspection relating to the air conditioning system, the manager has assured the Commission that quotes have been received and equipment ordered. The Commission for Social Care Inspection must be informed, in writing, once the new air conditioning unit has been fully installed. On both days of the inspection, the laundry area was observed to be well organised, however the Commission for Social Care Inspection is aware of concerns by relatives relating to insufficient laundry staff and missing clothing. Two residents confirmed to the inspector that they did not always get their clothes back in a timely manner and some items of clothing had been lost and not always located and returned. Two relatives surveys made reference to inadequate laundry procedures, resulting in lost items. A maintenance person is employed at the care home between 07.00 a.m. and 15.00 p.m. Monday to Friday. Both the manager and operations manager advised the inspector that the maintenance person’s role is being reorganised and streamlined to ensure their effectiveness. The training matrix provided to the inspector details that the maintenance person has up to date training relating to fire safety, fire drills, moving and handling, COSHH and health and safety. Some gaps in training as detailed above were noted for the domestic, domestic supervisor and laundry person. 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. The manager was advised that the hoist certificate details that the next examination date is overdue. The manager advised that one assisted bath is due to be replaced. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The level of staffing/staff deployment on occasions restricts the ability of the service to deliver person centred care and to ensure that people’s needs, can be met and that they are safe. Poor recruitment procedures and insufficient training mean that residents are not safeguarded and staff working at the care home may not have the necessary skills to meet the assessed needs of residents. EVIDENCE: The manager advised that staffing levels at the care home remain at 1 senior and 2 care staff on each floor between 08.00 a.m. and 20.00 p.m. each day and 1 senior and 1 member of care staff on each floor between 20.00 p.m. and 08.00 a.m. at night. The manager’s hours are supernumerary to the above and the deputy manager receives 12 hours per week as supernumerary. Current vacancies include a domestic/laundry person for 37 hours per week. An administrator is employed at the home between 10.00 a.m. and 18.00 p.m. Monday to Friday. On inspection of four weeks staff rosters and staff rosters examined over the Christmas period, it was evident that staffing levels as detailed above had not always been maintained or met and no Regulation 37 notifications have been received by us detailing a reduction in staffing levels and the measures Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 27 undertaken by staff to deploy additional staff to the care home to meet resident’s needs. On both days of inspection as previously stated, staff deployment within the home was, at times, not appropriate to meet the needs of existing residents and there were periods when residents were left without staff support. One resident advised the inspector that they did not always feel confident that there were sufficient staff on duty at all times and stated on occasions they had to wait for some considerable time before receiving staff assistance. Another comment was that “day staff are OK, but not all members of night staff complete regular checks as they should”. Issues relating to inadequate staffing levels at the care home were raised by relatives at a meeting on 10/3/08. Records indicated that an explanation was provided by the operations manager relating to how figures for staffing levels are set. The minutes of the meeting intimate that the Commission for Social Care Inspection set the staffing levels for home’s to follow. This is inaccurate as it is the registered provider’s responsibility to staff the home with sufficient numbers of staff according to the numbers of residents and their assessed needs. The Annual Quality Assurance Assessment under the heading of `Our evidence to show that we do it well` states, “The staff rota’s show that the correct number of staff are on duty at any time”. This does not concur with the above findings. It is evident that staffing levels may not always meet the needs of residents using the service and their health and welfare may be adversely affected. One staff survey returned to the Commission for Social Care Inspection confirmed that on occasions there have been insufficient staff on duty and that they did not always feel supported to enable them to meet residents’ needs. Staff spoken with during the inspection advised that inadequate staffing levels impact on the delivery and quality of care that can be provided e.g. bath schedules for some people were not always followed, lounge areas not adequately covered on occasions and actual time spent with residents could be limited. Of those relatives surveys returned to the Commission, comments were variable. These included, “very friendly caring staff”, “the actual care seems to be very good” and “my relative’s needs are generally met by the carers” to “inadequate care provided” and “care provided at the basic care level”. Comments were also recorded relating to staffing levels and these stated “ all staff appear competent, capable and friendly”, “I am not sure what the level of staff to residents should be but my impression at times is that staff are hard pressed to look after residents e.g. quite often residents in the lounge are unsupervised relying on the able bodied to get assistance for toilet etc”, “address staffing levels” and “I am not sure of the staff ratio at the moment but think it could be higher, particularly at the busiest times” . Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 28 The manager advised the inspector that a key worker system is to be introduced to the home. One relative spoken with advised the inspector that this had been discussed previously, however was concerned that no action had been taken to date. One relative survey commented “ The lack of a key worker scheme means that my relative does not feel that any specific person cares about them”. On inspection of staff files for those staff newly employed at Sycamore Court, not all records, as required by regulation, were available. Gaps were noted in relation to no photographs, the manager’s employment file only containing limited information, no healthcare declaration for one person, written references not from the most recent employer and the POVA 1st and Criminal Record Bureau check for one person received after they commenced employment at the care home. Current recruitment practices do not fully ensure that residents are safeguarded. Additionally of those staff files examined only two records of induction were available. The manager confirmed to the inspector that she had not received an induction and one staff survey returned to the Commission for Social Care Inspection office, confirmed that they had received no induction. One member of staff spoken with confirmed that they had received an induction, however this was not in line with Skills for Care and most elements had not been completed. This was of concern, as the member of staff had no previous care experience. The Annual Quality Assurance Assessment detailed under the heading of `What we do well`, “All new staff undertake induction and complete skill for care”. The Statement of Purpose also states “We have a robust induction programme which is completed by all new staff”. It is positive that the turnover of staff is low and the management team at the home has been successful in the recruitment of ‘bank’ staff. It was positive to note that over a four-week period, usage of agency staff at the care home was minimal, however the inspector was advised by staff on occasions, that the use of agency staff has been denied. Records indicated that three members of agency staff had been utilised, however no staff profiles detailing satisfactory checks had been completed by the external agency were available and no records of induction were available. On the second day of inspection the inspector observed the deputy manager undertaking an induction for an agency member of staff, however no documented copy of the induction was available. On the third day of inspection one member of staff was deployed from a ‘sister home’ to Sycamore Court. Records relating to this person (recruitment/induction) were requested, however no evidence was available. The member of staff confirmed to the manager that this was their second shift at Sycamore Court, however they were unable to verify if they had received an Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 29 induction previously. The manager conducted an induction with this person prior to them completing the shift. A copy of the training matrix was provided to the inspector. This detailed that 52 of staff have received training relating to fire safety, 78 of staff have undertaken training relating to fire drills, 70 of staff have completed food hygiene training, 81 have completed training relating to moving and handling, 41 have undertaken training pertaining to COSHH, 44 have health and safety training, 22 of staff have received training relating to infection control, 48 of staff have undertaken training relating to dementia awareness and 30 of staff have received training for the safer use of bed rails. It remains disappointing that training relating to those conditions associated with older people is limited and not seen to be a priority by the management of the home/registered provider. This means that some members of staff may not have the necessary skills and competence to meet the assessed needs of individual residents. The Statement of Purpose details “Following staff supervision and appraisal, and the receipt of any inspection reports or complaints indicating that further training is required, a training programme is compiled to ensure that we continue to assist staff in developing new skills as part of the home development plan”. The above was highlighted at the last inspection to the home and remains outstanding. Records also indicated that 6 staff had achieved NVQ Level 2, 2 staff had achieved NVQ Level 3, 5 staff are currently undertaking NVQ Level 2 and 1 member of staff is undertaking NVQ Level 3. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management arrangements in the home are unsatisfactory and the shortfalls identified throughout this report could adversely affect outcomes for residents. EVIDENCE: The manager has been in post at Sycamore Court since November 2007 and has experience working in care both within the private sector and within social services. The manager has achieved the Diploma in Care and has completed the Registered Manager’s Award in Management. The manager has past experience of managing a care home for older people. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 31 It is evident from this inspection that progress highlighted at the previous inspection to the home has declined, however it is recognised that the manager and deputy manager have only been in post since October/November 2007. At the time of the inspection, the manager had not received an induction from the registered provider and although there was evidence to indicate that the deputy manager had received formal supervision, no supervision records were evident for the manager. The manager advised the inspector that she was still trying to understand the organisations strategic systems but was now receiving support from the newly appointed operations manager. Comments received from relatives prior to the inspection were not positive and some people stated they had little confidence in the management of the home and did not feel their member of family was cared for in the most appropriate way. The latter resulted in some residents being moved from Sycamore Court by their next of kin as a result of concerns and having little faith that the registered provider would proactively respond to the issues raised. One relatives survey stated “We would like to see greater concern/response by management to issues raised and more involvement of senior management with individual residents”. Comments from staff relating to the management of the home were mixed, with both positive and negative comments. Staff spoken with advised that they felt the manager was approachable and doing her best, however records management was muddled and disorganised. Staff were also concerned that they had not received regular supervision and in some cases issues highlighted were not always actioned and/or followed through. Staff commented that this did not solely relate to the current management of the home. Areas which continue to require further development relate to care planning/risk assessments, proactive management of nutritional care needs for individual people, medication practices and procedures, staffing levels to meet residents needs, sustained training and development of staff and developing consistent staff supervision. Additionally the management of the home (refers to all staff) must ensure that recording keeping systems in the home are organised and better managed and therefore easier for staff to find documentation when requested. The management team at the home must demonstrate a proactive approach to addressing and sustaining good practice, so as to ensure residents continued safety, wellbeing and positive outcomes. On inspection of a random sample of supervision records for staff it was evident that formal supervision, is not happening as frequently as they should and in some cases records indicated that staff had not received supervision or only received one supervision session since the last inspection. The manager advised that she is aware of the shortfalls and is looking to address the issue as soon as possible, with other members of the management team undertaking the role of supervisor. The manager advised this, will only happen once senior staff had received appropriate training. The Annual Quality Assurance Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 32 Assessment details under the heading of `What our service does Well`, “Senior care staff have been selected with care, and support given to them via supervision to enable them to perform their role in a professional manner”. It also details under the heading of `How we have improved in the last 12 months`, “Staff supervision on regular and planned basis”. Neither of these statements concurs with the findings of the inspection. It was of concern that some issues highlighted during supervision/appraisal sessions have not been dealt with and there was no evidence of an action plan/outcome. For example issues were raised from one person in relation to staff shortages and the impact this has on providing appropriate care to residents. No information as to how this was to be managed was recorded or highlighted for further action. The manager advised that currently there is no formal quality assurance system in place to seek the views of residents, relatives, staff and other interested parties. The Commission for Social Care Inspection is aware that validation audits are regularly completed by the operations manager and management team of the home. The Annual Quality Assurance Assessment details that the management of the home will be sending out customer satisfaction surveys in the future. There was evidence to indicate that staff meetings have been undertaken fairly regularly, however night staff do not attend. The management team of the home must devise a way so as to include night staff as they are a key part of the staff team. Records of relatives/resident meetings were available, but evidence indicates these have been infrequent until recently. A health and safety policy was observed within the home. Accident records were inspected and these evidence that these mainly relate to people experiencing falls. Records were well maintained and included all necessary information. Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 1 X 2 Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care planning at the home must identify, and be effective in meeting all residents’ assessed needs. Staff must ensure that instructions within individual care plans are carried out. Previous timescale of 14.4.07 to 1.9.07 not met. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised. Previous timescale of 14.4.07 to 1.9.07 not met. Records of food/nutrition provided to residents in sufficient detail so as to determine whether the person’s diet is varied, balanced and/or satisfactory. People who use the service must be protected by having suitable arrangements in place for the control, administration and recording of medicines. Ensure residents are given DS0000018123.V360499.R01.S.doc Timescale for action 30/05/08 2. OP7 13(4) 30/05/08 3. OP8 17(2), Schedule 4 (13) This requirement was not met and we are now considering enforcement action. 4. OP9 13(2) 20/04/08 5. OP9 12(1)(a) 20/04/08 Page 35 Sycamore Court Version 5.2 6. OP12 16(2)(m) &(n) medication in accordance with the prescriber’s instructions. People residing at the care home must have their social care needs met to ensure they are stimulated and do not become bored. Previous timescale of 14.4.07 to 1.9.07 not met. All residents who live at the care home must receive adequate quantities of food so as to ensure their health and wellbeing. Previous timescale of 1.8.07 not met. 30/05/08 7. OP15 12(1)(a) This requirement was not met and we are now considering enforcement action. 8. OP16 22 9. OP18 13(6) All complaints received at the 04/04/08 care home to be dealt with within an appropriate timeframe so that people are assured that their concerns are listened to and taken seriously. 01/06/08 All staff to receive training 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. Previous timescale of 1.7.07 to 1.10.07 not met. Ensure that all areas of the home 04/04/08 are kept clean and reasonably decorated so that people can live in a homely and comfortable environment. Previous timescale of 1.9.07 not met. Ensure that the sluice room on the ground floor is locked and not accessible, and all COSHH items are stored securely so as DS0000018123.V360499.R01.S.doc 10. OP19 23(2)(d) 11. OP19 13(4) 04/04/08 Sycamore Court Version 5.2 Page 36 to ensure residents safety and wellbeing. Previous timescale of 1.8.07 not met. Ensure that the passenger lift is in working order so as to ensure that people on the first floor can access the community and others areas of the home when appropriate. CSCI to be informed in writing when operational. Ensure that at all times there are suitably qualified and competent staff on duty in sufficient numbers as appropriate to meet the needs of residents. Previous timescale of 21.4.07 to 1.8.07 not met. 14. OP29 19 Ensure that robust recruitment procedures are adopted at all times for the safety and wellbeing of residents. Previous timescale of 14.4.07 and 1.8.07 not met. 15. OP30 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 and to structured induction training. Previous timescale of 1.11.07 not met. 16. OP31 10(1) The manager of the home must manage the home with skill and competency so as to ensure the smooth running of the home and that residents needs are met. Ensure all staff working at the DS0000018123.V360499.R01.S.doc 12. OP19 23(2)(n) 28/04/08 13. OP27 18(1)(a) This requirement was not met and we are now considering enforcement action. This requirement was not met and we are now considering enforcement action. This requirement was not met and we are now considering enforcement action. 04/04/08 17. OP36 18(2)(a) 30/04/08 Page 37 Sycamore Court Version 5.2 care home, receive regular supervision so that they feel supported and able to undertake their job effectively. Previous timescale of 1.5.07 and 1.8.07 not met. This requirement was not met and we are now considering enforcement action. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP3 OP7 OP8 Good Practice Recommendations Confirm in writing to residents and their representatives that the home can meet their assessed needs. Ensure that daily care records record staff interventions/care provided to individual residents. The manager should liaise with healthcare professionals so that treatment/interventions for individual residents are carried out in private. Consider devising the activity programme in larger print and/or pictorial format so as to enable residents to make an informed choice. OP12 Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sycamore Court DS0000018123.V360499.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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