Inspection on 23/02/09 for Sycamore Court

This inspection was carried out on 23rd February 2009.

CSCI found this care home to be providing an Poor 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 17/08/09

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.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sycamore Court Magpie Lane Little Warley Brentwood Essex CM13 3DT     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Love     Date: 2 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 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: Conditions of registration: Category(ies) : Southern Cross Healthcare (West) Limited care home 39 Number of places (if applicable): Under 65 Over 65 39 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 1 5 0 9 2 0 0 8 Sycamore Court is a purpose built, two storey building situated in a rural location outside Brentwood/Warley and within easy access of A127 and M25. The home provides accommodation for 39 older people on two floors, in 39 single en-suite rooms. Other facilities include 4 lounges and separate dining areas. In addition the home benefits from a specially equipped hairdressing salon. A passenger lift provides access to all levels within the home. There are large open grounds with excellent views across the local countryside and a patio area with seating. Car parking facilities are available to the side of the property. The home is not serviced by any public transport. Brentwood station is approximately 3 miles away and the nearest bus stop is advised as approximately a 40 minutes walk. Care Homes for Older People Page 4 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 9.5 hours, with all but one key standard inspected. Medication practices and procedures were examined by a specialist pharmacist inspector. Additionally, progress against previous requirements and recommendations from the last key inspection were also examined. An Annual Quality Assurance Assessment was provided to us in September 2008. This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. Care Homes for Older People Page 5 of 34 As part of the process a number of records relating to people living in the care 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. Surveys for residents, staff and healthcare professionals were requested to be forwarded to the care home, however from discussions with the manager, we were advised that these were not received. The manager, operations manager and other members of the staff team assisted both inspectors on the day of inspection. Feedback on the inspection findings, were given as a summary to the manager and operations manager. The opportunity for discussion and/or clarification was given. As a result of concerns relating to care planning, risk assessing, meeting peoples healthcare needs and providing care in line with peoples care needs, a Serious Concern Letter was forwarded to the registered provider and manager. What the care home does well: What has improved since the last inspection? What they could do better: Records show that further development of the care planning and risk assessment process is required as shortfalls identified, place people at risk of not having all of their care needs met and provides staff with inaccurate and not up to date information about individual people who live at the care home. Residents health and welfare must be promoted and any issues/areas of concern promptly addressed and proactively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to recognise when to contact healthcare professionals and to provide appropriate interventions. Where people are at risk of losing weight, appropriate nutritional records are consistently maintained and include weight gain or loss and appropriate action taken. Care Homes for Older People Page 7 of 34 Provide appropriate social stimulation for those people who have poor cognitive ability and/or who spend a lot of time in bed. Staffing levels/staff deployment at the care home needs to be improved and maintained so as to ensure peoples safety and wellbeing. Further training and personal development is required for staff to ensure they have the skills and competence to meet individuals care needs and to deliver good care. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 34 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 34 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. Current and prospective people are provided with sufficient information so they can make an informed decision as to whether or not Sycamore Court is the right choice for them. Individual people can expect to have their care needs assessed before they are offered a placement. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective service users needs. Admissions are not made to the home until a full assessment is undertaken and where appropriate additional information had been sought from the persons placing authority and or hospital. As part of this site visit the care files for two people newly admitted to the care home (1 respite resident and 1 permanent resident) were examined. Records for the Care Homes for Older People Page 10 of 34 Evidence: permanent resident showed that their pre admission assessment was completed by the management team of the home prior to the persons admission and information recorded was observed to be detailed and informative. The care file for the person admitted on respite showed this person had previously undertaken a period of respite at Sycamore Court prior to their current visit, however there was no evidence to show that they had been reassessed prior to their latest respite period at Sycamore Court. The manager advised the person had been reassessed, however the pre admission assessment document could not be located at the time of the site visit despite time given to the management team of the home/staff team to find the document. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services/facilities provided. The home does not provide intermediate care. Care Homes for Older People Page 11 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Sycamore Court cannot be assured their care needs will be clearly and accurately recorded within a plan of care or that care provided by staff will meet their care needs, so as to ensure their wellbeing and positive outcomes. Evidence: Records showed there is a formal care planning system in place to help staff identify the care needs of individual service users and to specify how these are to be met by care staff, however not all areas of identified need were recorded within each persons care plan and in some cases there was limited information recorded as to how staff were to proactively manage the persons specific care needs. Additionally, formal assessments relating to dependency, manual handling, pressure area care, nutrition, falls and continence are also completed for individual people. Of 5 care files examined at random, deficits and shortfalls were highlighted within 4 of these. Further development in care planning/risk assessing is required to ensure the care needs of individual people are clearly recorded and staff have the most up to date Care Homes for Older People Page 12 of 34 Evidence: information to ensure appropriate levels of care delivery are undertaken. As part of this inspection a random sample of 5 care files were examined. Following observations of the lunchtime meal, the care files for two people were inspected in relation to their nutritional care needs. The care records for one person showed that a care plan was devised in relation to their poor dietary intake. Clear instructions for staff detailing specific care to be provided were recorded, however during the observation of the lunchtime meal it was evident that both senior care staff and care staff were not providing care in line with the persons care needs. Additionally where records showed the person was losing weight, there was insufficient evidence to show these were being monitored, with potential complications and problems not identified and dealt with at an early stage by staff, including prompt referral to an appropriate healthcare professional. Both the care plan and risk assessment recorded the person as being weighed monthly, yet we were advised by staff that the persons weight was being recorded on a weekly basis. Records showed the latter was happening, however over a 2 month period the person was noted as having lost 5KG in weight. The Professional Visitors record documented the resident was seen by a healthcare professional over the past 2 months, however we were advised by the team leader that there had been little discussion by the management team/staff team of the home, to alert the healthcare professional to the above continued weight loss. Both food intake charts and nutrition intake charts were requested for the above person. Specific records recording dietary/fluid intake were seen to be muddled and not always recorded. Where records were in place these were not consistently completed and in some instances, gaps were noted. The above was not an isolated case and the second care file examined pertaining to the persons nutritional care needs, concurred with the above findings. The care plan and risk assessment had not been updated to reflect that over a 5 month period, the person had lost nearly 8KG. On inspection of their Professional Visitors record as far back as August 2008, there was no evidence recorded that the management team of the home/staff team had referred the weight loss to an appropriate healthcare professional. As stated above, specific records recording dietary/fluid intake were muddled, not always recorded and where they were in place, these were not consistently completed. As a result of the above concerns, a Serious Concern letter was issued to the registered provider and manager. We are concerned that similar issues have been raised at previous inspections to the home within the past 12 months and as a result of shortfalls identified in March 2008, relating to the poor management of nutrition, a Statutory Requirement Notice was issued. We remain concerned that progress highlighted at the last key inspection in September 2008, has not been sustained. It is Care Homes for Older People Page 13 of 34 Evidence: evident from inspection of the registered providers policy pertaining to Nutrition and Nutritional Screening that both the management team and care staff team are not complying with the above policy and people at the care home are being placed at risk of not having some of their specific healthcare needs met. During the inspection we were made aware that one persons blood sugar levels had been low the previous day. The member of staff spoken with stated that healthcare professionals had visited the home, undertaken a blood glucose monitoring test and provided the person with a sugary carbonated drink. On inspection of the persons care plan pertaining to their diabetes, this was seen to be ambiguous, providing no clear definition for staff as to what the persons normal blood glucose levels were or the frequency of healthcare interventions/monitoring provided. Additionally the care plan, daily care records and Professional Visitors records provided no information as to the outcome of the above visit by healthcare professionals and/or actual interventions provided. We discussed the above isssues with the manager and operations manager. We raised concerns that infrequent blood glucose monitoring could result with the persons specific healthcare needs not being met in a timely manner and interventions provided by staff being reactive, rather than proactive. We were advised by the operations manager that it was not company policy for staff working within a residential care home to monitor/record peoples blood glucose levels and only registered nurses could do this, however they would require special training. During the site visit the operations manager contacted Southern Cross Healthcares, Group Clinical Nurse Advisor and Group Operations Director for advice, however it was evident that the interpretation of the companys own policy was inconsistent by both parties. On inspection of the policy for Blood Glucose and Capillary Blood Glucose Monitoring dated May 2008, this recorded, It is Southern Cross Healthcare policy that only staff members who have been trained in blood glucose monitoring are permitted to carry out this procedure. Following the inspection we were advised by the managing director that residential care staff will not be permitted to carry out blood glucose monitoring and where this is required, the task will be carried out by a healthcare professional. The organisation will ensure that future documentation reflects accurately how individuals with diabetes will be monitored so as to ensure their well being. The care file for the person admitted on respite, recorded their care needs as of November 2008 (last period of respite). Records showed this had not been updated or been assessed as remaining the same. The AQAA details under the headings of what we do well and our evidence to show that we do it well, We evaluate the care plans monthly, as a minimum, and update Care Homes for Older People Page 14 of 34 Evidence: them should there be any changes and Care plans and risk assessments are in place evidencing all our service users needs and how we meet their needs. This did not concur with our findings at this inspection. Staff interactions with people living at the care home were observed on several occasions to be mainly task orientated. In general little verbal interactions were noted between some members of staff and individual residents. However one member of staff was observed to interact in a positive manner with several residents and this was seen to be undertaken with respect and dignity. Residents were seen to enjoy the interactions. Practices and procedures for the safe storage, handling and recording of medication were examined by a pharmacist inspector. The home has good clear written policy and procedures for the safe use of medicines to protect residents although some aspects of this are not followed by staff. Storage for medication is adequate and the temperature satisfactory. Daily records are made of the temperatures, which were consistently below 25C. The daily records for the fridge temperature show that they are within the acceptable range. There were items kept in the fridge which were in use but did not carry a date of opening. Such items have a reduced shelf life when opened and so if the date of opening is not recorded then these may be used beyond their useable life. We expect this to be managed by the home rather than make a requirement on this occasion. Dedicated storage is provided for controlled drugs but this cupboard is not secured to the wall properly. This was noted on the previous inspection and the provider stated that this had been checked and does comply with the relevant regulations. It does not. The requirement has therefore been repeated with a new timescale for action. There were some controlled drugs that had been in stock since December 2008 but which were prescribed for a person no longer resident in the home. It is important that such medicines are disposed of promptly. Again, we expect this to be managed by the home rather than make a requirement. Entries made in the controlled drugs register were satisfactory. Medication is only given to residents by trained staff. We watched some medicines being given to residents at lunchtime. The process was done with regard to peoples dignity and personal choice. Records made when medication is received into the home and when it is given to residents are reasonably good and demonstrate that people receive the medication as prescribed. There were very few discrepancies in the medication and medication records and evidence was seen that the records are checked regularly by staff. Despite Care Homes for Older People Page 15 of 34 Evidence: this however, some deficiencies were found: for two residents where medication must not be given at the same time, the record did not accurately reflect the time it was given and another persons medication instruction had been changed but without any documented approval by their GP. Where medication records are hand-written, the date of use was not always clearly recorded. Although the above need to be addressed, the quality of medication records has improved over previous inspections and we consider that the requirement made on the last inspection for suitable records to be kept to have been met. In one persons room we found medication which was not recorded on the persons medication record. There was also no record of this medication in the residents care plan and no risk assessment carried out or documented. Where people look after their own medicines, the risk to both themselves and other people must be safely managed. Care Homes for Older People Page 16 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people living at the care home can be assured they will have their social care or dietary needs met which meets their specific requirements. Evidence: An activities co-ordinator is employed at Sycamore Court for 35 hours per week, Monday to Friday, however we were advised that these hours are flexible to cover evenings, weekends and special events e.g. quiz night, Indian Head massage, pie and mash supper. A copy of the weeks activity programme was noted to be displayed on both the ground and first floor resident notice boards. As highlighted at previous inspections to the home, consideration should be made to devise the activity programme in a pictorial format, so that those people with poor and/or limited cognitive ability are able to make an informed choice. On inspection of 4 weeks activity programme, this showed that people living at Sycamore Court are able to participate within a varied range of activities. These include bingo, sherry morning, reminiscence, Scrabble, external entertainers, arts and crafts, quizzes, film afternoons, dominoes, baking, reading, gentle keep fit and religious observance etc. A newsletter continues to be compiled Care Homes for Older People Page 17 of 34 Evidence: and distributed to residents and their relatives. We were advised that a recreational activities record is completed for each person living within the care home. Additionally records showed that a Map of Life had been completed detailing their personal preferences, likes and dislikes and those people important to them in their life. Of those care files case tracked, not all care plans made reference to their social care needs. Records show for those people who have limited communication/poor cognitive ability and who are bedridden, there is a lack of social stimulation. This was discussed with both the manager and operations manager at the time of the site visit and both confirmed they had noted the above. We were advised that monthly workshops are planned for all activity co-ordinators within the organisation. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. There is a rolling 4 week menu in place and from inspection of this, showed that people within the home are provided with a varied diet throughout the day. People living at the care home are able to choose where they wish to eat their meals e.g. in the dining room or in the comfort and privacy of their own room. In addition to the main menu, alternatives are readily available. The lunchtime meal was observed within the ground floor dining area. A menu depicting choices available was readily available on each table. The menu was noted to be handwritten. As stated at previous inspections to the home, consideration should be made to devise the menu in larger print and/or pictorial format so as to ensure that people living at the care home are able to make an informed choice. Not all people spoken with were able to advise as to the lunchtime meal choices available. Tables were observed to be attractively laid with tablecloths, condiments, glasses, vase of flowers and serviettes. A choice of drinks was readily available, however it was observed that several people who are able/have the ability to pour drinks for themselves are not provided with the opportunity to undertake this task. During the observation of the lunchtime meal, one person was provided with their meal at 12.25 p.m. The person was noted to eat very little and was seen to push their plate of food away on several occasions. No members of staff were seen to provide any verbal or physical encouragement to the resident and at 12.50 p.m. their plate was removed from the table. No attempts were made by staff to provide an alternative meal, however it was noted that the person had only eaten 3 spoonfuls of food. The senior in charge of the shift was overheard to say to a member of care staff, Did she eat anything. The carer was seen to shake their head. At 12.55 p.m. the resident was Care Homes for Older People Page 18 of 34 Evidence: provided with their dessert. They were observed to lick their spoon on several occasions but made no attempt to eat their dessert. No effort was made by staff to provide support and/or encouragement to the person. The above was also observed by the operations manager. The above poor care practices by staff are not in line with the persons care needs or in line with their plan of care. As stated within the Health and Personal Care section of the report, we are concerned that people within the home are being placed at risk of not having their nutritional care needs met. It was also noted from the time of our arrival, that no drinks (jugs of juice/water) were readily available for people, either on the ground or first floor lounge areas. People confirmed they had received a drink at breakfast, however the next drink provided was not until 11.05 a.m. From observations it was noted that people were given a choice of either coffee or tea. The above remains outstanding and has been highlighted at previous inspections to the home. Comments from people spoken with on the day of the site visit relating to the quality of meals provided were observed to be generally positive and included, the food is very good and yes the meals are lovely, theyre not bad. Care Homes for Older People Page 19 of 34 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 be confident that their complaints will be listened to and appropriate action taken by the home. Evidence: There is an appropriate complaints policy and procedure in place at Sycamore Court. Additionally there is information recorded within the Service Users Guide pertaining to complaints. Since the last key inspection 2 complaints have been raised, pertaining to a lack of management presence at weekends/low staff morale and poor care practices. Records showed that the management team of the home dealt with the above complaints and all issues were resolved in a timely manner. People spoken with confirmed they were confident to raise concerns and/or issues and knew who to speak to. Records of compliments were readily available and included, I would like to thank you very much for all the love, kindness and care that you gave to my relative whilst they were with you at Sycamore Court. It was comforting to know that they were being well looked after and that they were happy and Thank you very much for the care provided to our relative in the time they lived at Sycamore Court. It was a comfort to their family knowing that they were well cared for. Since the last key inspection, no safeguarding issues have been raised. Staff spoken Care Homes for Older People Page 20 of 34 Evidence: with demonstrated and awareness and understanding of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge of the shift and/or the manager. On inspection of the staff training matrix and training statistics sheet, records showed that 19 out of 27 members of staff have up to date safeguarding training. Care Homes for Older People Page 21 of 34 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 can expect to live in a home that is comfortable, safe and homely and which meets their needs. Evidence: We undertook a partial tour of the premises. A random sample of residents bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display e.g. ornaments, photographs etc. The home was observed to be clean, tidy and odour free. Two health and safety issues were highlighted at the time of the inspection and related to the cleaners store cupboard on the ground floor being left unlocked for a period of time and several COSHH (Control of Substances Hazardous to Health) items being easily accessible to people living within the care home. We observed that one key-pad on the first floor was intermittently not working and posed a potential risk to some people on the first floor. We were advised by staff that there are people living in the care home who are at risk of falls/prone to wandering. The key pad issue was discussed with the operations manager and maintenance person at the time of the site visit and we expect this to be managed by the home rather than make a requirement on this occasion. Care Homes for Older People Page 22 of 34 Evidence: A maintenance person is employed at the care home between 07.00 a.m. and 15.00 p.m. Monday to Friday. The staff training matrix showed that the maintenance person has up to date training relating to fire safety, food hygiene, moving and handling, health and safety, safeguarding and infection control. There is an on-going refurbishment and redecoration programme in place. A random sample of maintenance records/certificates were examined and these showed that certificates examined in relation to the passenger lift, gas and electrical safety installation, hoists and employers liability were noted to be in date and fully operational. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the care home cannot be assured there will always be sufficient staff on duty or that staff on duty are competent to undertake their role. Evidence: The manager advised us that staffing levels at Sycamore Court 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 and an administrator is employed Monday to Friday between 10.30 a.m. and 18.30 p.m. In addition to the above, ancillary staff are employed and these include cooks, housekeepers and domestic staff. We were advised that there are current vacancies for domestic staff and care staff hours. When we arrived to undertake the inspection it was noted that staffing levels on the ground floor were not appropriate as they were short by one member of staff. We were advised by the team leader in charge that a member of staff had telephoned in sick that morning, however no efforts had been undertaken by them to get additional staff deployed to the care home. The team leader advised that a night carer who had been on duty had stayed at the care home until breakfast had been completed, however on inspection of time sheets and signing in/out sheets, there was no evidence Care Homes for Older People Page 24 of 34 Evidence: to support the claims made. Signing in/out sheets were observed to be poorly completed as not all staff recorded their arrival/departure to and from the home and in some instances, records were completed retrospectively. This was discussed with the operations director who was visiting the care home, the operations manager and manager. The operations manager arrived at the care home shortly after our arrival and made arrangements to deploy additional staff to Sycamore Court. An additional 2 members of staff arrived at the care home mid morning from a sister home of the company. Observations undertaken during the morning showed staff deployment on the ground floor as poor and there were several occasions when people within the main lounge area were left without staff support. On inspection of 4 weeks staff rosters, these showed that staffing levels as detailed above have not always been maintained. We have not been notified via Regulation 37 Notifications when staffing levels have not been attained and the measures undertaken by the management team of the home/registered provider to address the shortfalls. We were advised following the inspection by the operations director that the manager often covers staff sickness/annual leave. Whilst this is recognised, the staff rosters examined did not accurately reflect this. We were advised by the manager that no agency staff have been utilised at the care home for some considerable time and wherever possible, existing staff within the home or from other homes within the company are deployed to the home. The AQAA details under the heading of our evidence to show that we do it well, Our staff rotas show that the correct numbers of staff are on duty at any given time. This did not concur with the inspectors findings. At this site visit 3 staff recruitment files were examined (2 for the newest people admitted to the care home). All records as required by regulation were readily available. Records of induction were evident for both newly appointed members of staff and following discussions with one member of staff this was deemed robust. On inspection of the staff training matrix and training statistics sheet, records showed at the time of the site visit that the majority of staff have up to date training relating to core subject areas (fire safety awareness, food hygiene, moving and handling, safeguarding and infection control). Records showed that 2 members of night staff do not have up to date manual handling training and some gaps were noted in relation to health and safety and COSHH (Control of Substances Hazardous to Health) training. Additional gaps in training were highlighted for those conditions associated with the needs of older people e.g. pressure area care, nutrition, falls management, Parkinsons Disease, sensory impairment etc. We were advised that currently, 10 members of staff have attained NVQ Level 2, 1 member of staff has achieved NVQ Level 3, 2 members of staff are currently undertaking NVQ Level 2 and 5 people are undertaking NVQ Level 3. Care Homes for Older People Page 25 of 34 Care Homes for Older People Page 26 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are some positive outcomes for people living at the care home, shortfalls identified, potentially place people at risk of not living within a home that is well run and/or managed. Evidence: The inspection was conducted with the manager and operations manager. The manager has many years experience in caring for older people and has been managing Sycamore Court since November 2007. Since the last key inspection, the manager has submitted an application to us, so as to be formally registered. The manager advised that the ethos of the service is to, provide people coming into Sycamore Court with a home from home, that is friendly and welcoming. The aim is for people to have a fulfilled life, to achieve their potential and to gain new experiences. It is evident from this inspection that 5 statutory requirements highlighted at the last Care Homes for Older People Page 27 of 34 Evidence: key inspection have been addressed. Evidence from this inspection show that further development is required in relation to some aspects of the care planning/risk assessing processes, ensuring that the healthcare needs of people living at the care home are met and where appropriate, healthcare professionals are consulted and interventions are provided. We are concerned that progress highlighted at the previous key inspection, has not been maintained and/or sustained, providing poor outcomes for some people living at Sycamore Court. We are aware that much support and guidance has been provided to the manager by the organisation over a substantial period of time. Following discussions with the manager at the time of the site visit, we were advised that a daily audit of 3 care plans is conducted by them, however it is of concern that issues highlighted within the Health and Personal Care section of the report were not picked up sooner and effectively managed to ensure positive outcomes for people. The manager and operations manager expressed concern about some senior members of staffs competence/performance. The manager concurred with the inspectors observations during the site visit pertaining to poor record management e.g. documentation not easily accessible and muddled. Additionally the manager concurred that senior staff were slow to take the initiative when required and/or to be confident in managing the shift effectively. It is of concern this has not been addressed sooner and effectively managed by the manager, so as to ensure that people who use the service, consistently receive positive outcomes. There is a quality assurance system in place at the home to seek the views of residents, relatives and other interested parties about the quality of the service provided at Sycamore Court. This was completed in January 2009 and 10 questionnaires were returned to the home. All comments received were noted to be positive and included, There has been a big improvement to the home, All the staff are friendly and efficient and We would be happy to have our relative come back and stay for respite anytime. In addition to the above, Regulation 26 visits are conducted by the operations manager once monthly. We were advised that resident/relative and staff meetings are held at the care home, however on the day of the site visit, some records were noted to not be readily available and/or missing. Appropriate policies and procedures relating to health and safety are readily available within the care home. Staff spoken with confirmed they have access to these as and when required. Care Homes for Older People Page 28 of 34 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 and 15/10/08 not fully met. So as to ensure that risks to residents can be and are minimised to ensure their health and safety. 01/04/2009 2 7 15 All people admitted to the 01/04/2009 care home must have a detailed plan of care. Care planning at the home must identify and be effective in meeting all residents assessed needs and be regularly updated/reviewed to reflect the most up to date information. Previous timescale of 30/5/08 and 15/10/08 not met. This will ensure that staff have the most up to date information so as to deliver appropriate care in line with peoples care needs. Care Homes for Older People Page 29 of 34 3 8 12 The health and welfare of 23/03/2009 individual residents needs to be promoted and proactively managed. Previous timescale of 15/10/08 not met. This will ensure that where people receive support, records are updated, staff have the skills to recognise when to contact healthcare professionals and to provide appropriate interventions. 4 9 13 Medicines controlled under 31/03/2009 the Misuse of Drugs Act must be stored in accordance with the Act and associated regulations. Previous timescale of 30/11/08 not met. This will protect residents medication from misuse and diversion. 5 27 18 Sufficient staff must be on duty at all times. Previous timescale of 12/6/08 and 15/10/08 not met. To ensure that the numbers and deployment of staff is appropriate to meet the needs of the people at Sycamore Court and to ensure their safety and wellbeing. 20/03/2009 6 30 18 Staff must receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people. 01/06/2009 Care Homes for Older People Page 30 of 34 Previous timescale of 1/9/08 and 1/1/09 not fully met. This will ensure that staff have the competence, confidence and ability to meet residents care needs. 7 36 18 Staff must receive regular supervision. Previous timescale of 1/7/08 not fully met. Not inspected on this occasion. So as to ensure that staff feel supported and residents know that staff are appropriately managed. 20/03/2009 Care Homes for Older People Page 31 of 34 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 8 17 Where people are at risk of losing weight, maintain appropriate nutritional records, including weight gain or loss and appropriate action taken. So as to ensure peoples healthcare and wellbeing needs are maintained and met. 20/03/2009 2 9 13 Where people look after their own medicines, the risks to themselves and other people must be assessed and managed. This will protect people from harm by having access to medicines not prescribed for them. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 34 1 8 Nutritional records for people living in the care home to be consistently completed so as to determine food/fluid taken and whether or not the diet is satisfactory. Consider devising the activity programme in a pictorial format so that people living at the care home are able to make an informed choice. Consider devising the menu in a pictorial format so that people living at the care home are able to make an informed choice. 2 12 3 15 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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