Inspection on 12/12/07 for Sycamore Hall Care Home

This inspection was carried out on 12th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sycamore Hall Care Home 23/10/09

Sycamore Hall Care Home 07/10/09

Sycamore Hall Care Home 09/12/08

Sycamore Hall Care Home 09/01/07

Sycamore Hall Care Home 07/03/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sycamore Hall Care Home Kearsley Road Ripon North Yorkshire HG4 2SG Lead Inspector Anne Prankitt Unannounced Inspection 12th December 2007 09:15 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 Hall Care Home DS0000065290.V353411.R03.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 Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Hall Care Home Address Kearsley Road Ripon North Yorkshire HG4 2SG 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) 01765 606025 01765 609437 liz@premiernursinghomes.com Premier Nursing Homes Limited Elizabeth Corser Care Home 62 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (62) of places Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Sycamore Hall is a care home providing nursing and personal care for up to sixty two people who suffer from dementia. The nursing unit of 32 beds is located on the first floor and the residential care unit of 30 beds is on the ground floor. It is a modified and extended building, which was previously part of Ripon College and in the past was used as a Hall of residence and latterly, a conference centre. It is built on two floors, and there is a vertical lift providing level access to the first floor. There is car parking provided at the front of the building. There are landscaped areas to both sides and two enclosed, part paved garden areas. The registered manager confirmed on 12 December 2007 that the weekly fees range from £510 to £585, plus the registered nursing care contribution where this is applicable. Chiropody, hairdressing, toiletries, newspapers and dry cleaning is not included in this fee. The home has a brochure which is available for people before they move into the home. People are given further information in the service users’ guide once they are admitted. A copy of the inspection report is available in the front entrance of the home for those who wish to look at it. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit, the registered manager, Liz Corser, returned a self assessment called an ‘Annual Quality Assurance Assessment’, which provided information about Sycamore Hall. Surveys were sent to a selection of relatives and some visiting professionals. A record has also been kept about what has been happening at the home since the last key inspection took place in January 2007. This includes the results of a ‘thematic inspection’ which took place in September 2007, and which looked specifically at how the home makes sure that people’s privacy and dignity is protected. The commission does not publish the results of a ‘thematic inspection’, but the registered manager has made it available for people to see. All of the information, including that which was gathered at the site visit, was used as part of this key inspection. Five hours preparation took place before the site visit, which lasted for approximately eight hours. The registered manager and her deputy were available throughout. The area manager and operations manager were also available for the majority of the visit, and feedback was provided to everyone at the end. The site visit consisted of an inspection of the communal areas, and a sample of private bedrooms. Kitchen and laundry services were also looked at. A selection of documents were looked at, including a sample of care plans, health and safety records and staff records. A special observation was carried out on the first floor of the home. The people who live on this floor have nursing needs. The purpose of this two hour observation was to judge the quality of the care provided to people who are less able to express their views, in an attempt to understand their experiences, and how staff interact with them. What the service does well: People are given information in a variety of ways before they are admitted. This helps them to make a more informed decision about whether Sycamore Hall will be a suitable place for them to live. The registered manager makes sure that she gets information from other professionals so that she can check that the home can meet the needs of Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 6 people before they are admitted. This will help to make sure that the home has the right resources to meet the person’s needs. Relative’s comments included ‘They give a good all round service and care for my relative’, ‘On the whole I and my family are satisfied with the standard of care’. Another said that they were pleased with the way that their friend had settled. Visitors are made welcome. One commented how this had helped them to feel involved. They said that the staff were ‘very kind’. This helps to maintain important links between people and those who are important to them. People like the food at the home. One relative said ‘The food is excellent’. Staff know what to do if someone complains to them. They also understand that they must pass on any concerns if they think that a person is not being treated properly. This will help to keep people protected from harm. The environment is kept clean, and it smells pleasant. A relative commented that it was ‘clean’, and that ‘undesirable smells are kept to a minimum’. Another said that it was ‘spotlessly clean’. People can bring their own belongings into their bedrooms. This helps to make it pleasant for those who live there. People and their families get a satisfaction survey each year from the company, so that they have the opportunity to comment on what the home does well, and what it could do better. This helps the registered manager to have a better view about where improvements need to be made for people. What has improved since the last inspection? There were no requirements made in the last key inspection report. However, the registered manager has looked at the recommendations made, and plans to request a power assisted hoist, and extra activities hours, when she submits her business plan to the company in the new year. From the recommendations made within the ‘thematic inspection’ report, the registered manager has already taken steps to make the environment more interesting for people who live on the first floor. She has purchased ornaments and pictures, and has had the first floor communal area redecorated. The registered manager has also held a staff meeting to look at ways in which people’s care plans can be made more person centred. A care staff meeting is also planned. This will help to make care more individual. The company is planning to send satisfaction surveys to professionals in the community who provide a service to people who live at the home. This will help to check that they are satisfied with the service that the home is providing their clients, and will give the registered manager information about where the home provides a good service, and where improvements are needed. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 7 The company has made some changes to the Statement of Purpose, which will need further attention to make sure that it explains to people how the home caters for the needs of people with dementia, and how staff are trained to meet these needs. What they could do better: 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 Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 8 be made available in other formats on request. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 9 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 Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 10 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 People who use the service experience good quality outcomes in this area. They can be confident that their needs will be assessed before they are admitted. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager visits people who have been referred to the home, when she carries out an assessment of their needs. Information is also collected from other professionals, such as care managers and hospital staff. This helps to check that the home will be able to meet these needs properly. People and their relatives are offered the opportunity to look round the home before they move in if they wish, so that they can see what it is like. The registered manager explained that people can also visit for the day, or overnight if there is a vacancy. For people who cannot visit, pictures can be provided of the home, and of the bedroom that they may be allocated, so that they can see whether they like it. This helps them to make more informed decisions about whether they want to live there. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 11 The company is also in the process of making improvements to the Statement of Purpose so that it explains clearly to people what the home provides, and how. There are only a limited number of ‘hospital type’ beds available at the home. The majority of beds are of the divan type. The registered manager gave assurance that this is one factor that she takes into account when carrying out her assessment. She confirmed that she would make sure that this equipment was provided before the person was admitted if it was needed. This will help to make sure that people’s ongoing health needs will continue to be met. Some of the information asked for in the pre admission assessments seen was not completed. The registered manager explained that this information was not always available. But staff spoken with said that the registered manager gives them sufficient information about the person before they are admitted so that they know what personal care is needed, and where there may be risks associated with their care. This will help to make sure that the right care is provided as soon as the person arrives. In support of this, two visitors commented that their relatives had settled well since moving to the home. Intermediate care is not provided at the home, so standard 6 is not applicable. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 12 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 People who use the service experience adequate quality outcomes in this area. Information collected about people’s social and emotional needs, and how risk is managed, is not sufficient enough to ensure that care provided by staff will be based on people’s holistic needs and desired outcomes. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager is still putting plans into place to address the recommendations made at the thematic inspection held in September 2007, where shortfalls were identified in the information kept about people, and how their care can best meet their social, emotional and psychological needs, and any risks associated with this care. Because of this, opportunities that have arisen since the thematic inspection for newly admitted people to have a care plan based on their personal desired outcomes, have not been taken advantage of. Information provided about people’s individual needs, and what makes them different from the next person, has not always been considered when planning their care. For instance, there was no care plan in place to explain how staff should support a person identified before admission as having limited vision. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 13 And where staff had assessed a person as being at high risk from pressure damage, a care plan had not been completed about the reason why equipment had not been provided, despite this being identified as a risk on the assessment completed by the care manager before the person was admitted. The registered manager explained that staffing problems have delayed the progress that she had hoped to make, and have caused review of some care plans to fall behind. This needs to be addressed, and staff must begin to link the information they gather when they complete risk assessments, to care plans. As part of this, relatives should be encouraged to become involved in the review of the care plans where the person does not have the capacity to comment upon their care, and whether it is right for them. The registered manager has now held a meeting with trained staff to work towards the recommendations made, and plans a further meeting with care staff so that everybody has a clear understanding about the improvements that staff need to work towards. This will help to assure people that they will receive good quality person centred care. To assist with this, the company is introducing new documentation, which will lead staff away from the more generic plans of care that are currently in place, and which do not guide staff to focus on the needs of people with dementia. This will help care staff to think about the true sense of each individual whose care they are planning. Despite these shortfalls, the majority of relatives spoke positively about the care provided at the home. Comments included that people get ‘care and comfort required’, that ‘They give a good all round service for my relative’, and that ‘They care for people with dementia in very difficult circumstances’. One isolated comment was less favourable, and suggested that whilst basic care was provided, it could be offered with more dignity and communication. People living on the ground floor are admitted for personal care only. Any nursing care needed is sought appropriately from the community nursing team, with whom the staff have forged good links. People admitted for nursing care have their nursing needs met by nursing staff at the home. A health professional commented that ‘Visits are always appropriate’, and that ‘the staff are usually well aware of the patient’s medical background and history of the current illness’. Some of the people living on the ground floor are more able to express their needs than those on the first floor. Staff interacted well with them. Staff were polite, and showed respect. People responded to them well. Observations on the first floor identified that some staff did not always take the opportunity to interact with people when they were not busy, and did not always provide an explanation before they were going to provide people with Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 14 assistance. For instance, one person was wheeled backwards in their chair without any apparent explanation by staff, one of whom put an apron on a person without telling them first what they were about to do. People were not being moved in a safe way, and staff did not use the equipment that was available to them. This increases the risk of people feeling out of control and not included, does not uphold their dignity, nor does it make sure that they will get care in the safest way. Staff look after people’s medication on their behalf. Medication received into the building from the pharmacy is checked, but the records are not signed to say how much has arrived and who has made the check. By doing so, a better check for errors could be made when the registered manager audits people’s medication. Senior care staff manage the medication of those people living on the ground floor. The registered manager explained that these staff have undergone training provided by the dispensing pharmacy, and through their National Vocational Qualification training. Staff who work as care assistants, but who are qualified nurses in their own country, are trained by the registered manager in house. There have been two medication errors since the last key inspection. The registered manager explained the action she took at the time to make sure that staff were handling medication in a safe way. However, this action was not recorded in the supervision records seen. Any future supervision should be recorded, so that safe practice can be monitored, and the need for additional training or supervision easily identified, so that the risk from further error is minimised. The registered manager should also check whether the training that staff have received meets current standards, and should consider accessing further suitable training for them where this is necessary. The random audit on the day identified that people’s medication was being handled and stored appropriately. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 15 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 People who use the service experience adequate quality outcomes in this area. Important links between people and their families are encouraged. Better knowledge of people’s social needs would help staff to tailor the activities programme to personal preferences. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager explained that feedback from the most recent satisfaction survey sent to people and their relatives by the company has resulted in her decision to publish the planned activities for the week. This identifies that she is listening to the views of people. The activities programme focuses mainly on group activities, although examples were given where individual activities are offered. For instance, one person enjoys days out from the home on a regular basis. The home’s newsletter tells people what has been happening at the home, and includes details about trips taken away from the home during the summer, and regular in house events, such as lottery and raffles. The registered manager also encourages people who are able, to attend health appointments at the local dentist or doctors surgery. This helps people to maintain important links with, and to remain included in, the community in which they live. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 16 The activities person works twenty hours each week. This limits her availability to two hours on each floor per day from Monday to Friday. The registered manager plans to request additional activity hours in her business plan for the New Year. This would be of great benefit for the people who live at the home, and would allow for further development of individual activities plans to meet individual needs and interests. However, the company is looking at alternative ways in which this can be achieved so that the provision of meaningful activities becomes the responsibility of all staff over a twenty four hour period. Feedback from relatives prior to this inspection included comments such as ‘They talk to my relative regularly, even though my relative cannot speak much. I would like …… to be taken out into the garden more often but this is not always possible if the staff are short on that day’, ‘Perhaps more day to day stimulation – the TV seems to be on mainly’. The activities person is flexible, and had rearranged her schedule so that she could be present for the Christmas pantomime, which was due to take place at the weekend. This meant that there were no activities on the site visit on the first floor of the home, because she was not on duty. However, some people on the ground floor enjoyed dancing sessions with staff. They also chatted in small groups, enjoyed looking at books that had been made available, and admired the fish tank, which the registered manager has recently provided. They went outside to check what the weather was like, and to look in the enclosed garden. This helps to keep people orientated. Ministers from Church of England and Catholic denominations visit the home on a regular basis, and a service is held fortnightly. This helps to meet people’s spiritual needs. The care plans explain what choices people have made about how they want to spend their day, when they choose to rise and retire, and when they like to bathe. Staff said that they try to be as flexible as possible when providing care although a comment was made by a member of staff that it is the expectation of some staff that certain people will be in bed by a certain time. The registered manager was aware of this, and stated that she continually enforces that the choice of individuals comes before the preferred routine of the staff. Visitors are welcomed to the home at any time. They said that they are always made welcome. Some were offered drinks, and could see their relatives in private. People appeared to enjoy the meal provided. They are offered four meals each day, and are offered a choice of menu. Staff have access to the kitchen at night so that they can prepare food for people if they are hungry. One person said ‘I like coffee, and I can have a cup whenever I want’. The chef is aware of people’s dietary needs, because the staff give her a sheet explaining what these are whenever a new person is admitted to the home. This helps to make Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 17 sure that they get the right nutrition. People who need their food liquidised are served this in separate portions, so that it looks more appetising. The mealtime on the ground floor was relaxed, and people were free to come and go from the dining area as they wished. On the first floor, the service was less relaxed. A number of people need help to eat their meal, but there was only limited conversation offered from the staff who assisted them. Staff should recognise the mealtime as a social occasion for people, and make full use of the time that they have with people to engage in conversation whilst assisting them. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. People are protected by staff who will listen to and act upon their complaints, and who will report matters of concern to the right person for investigation. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the entrance to the home. It gives timescales by which people can expect a response from their complaint. There have been no complaints recorded as being received since the last key inspection in January 2007, but there is a means of recording any concerns should they be made. This will help the registered manager to keep track of any complaints made, and provides a record of what action was taken as a result. Relatives spoken on the day of the site visit said that they had no complaints. Four out of six relatives who returned their surveys said that they knew how to make a complaint. Five out of six said that any concerns raised had always or usually been responded to appropriately. One relative commented upon the manager, stating that she was ‘always available and welcoming’, whilst another said ‘any special requests are promptly acted upon’. One isolated comment was made that, although action was taken in the short term when concerns were raised, some slippage had occurred subsequently. Staff spoken with knew that they had a responsibility to pass on complaints to the registered manager for her attention. They also knew that they must pass Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 19 on any matters where they thought that people living at the home were not being treated properly. The registered manager understands her role in passing on concerns to the local authority for investigation, and the company is in the process of amending the abuse policy so that it clearly reflects the action to be taken if a staff member is found to be not fit to work with vulnerable people. This helps to keep vulnerable people properly protected from avoidable harm, and ensures that prompt action is taken where allegations are made. The registered manager needs to make sure that all staff have received training in abuse awareness, so that she can be reassured that all, without exception, are clear about what constitutes abuse, and what action staff must take if they suspect that a person has been mistreated. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 20 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 People who use the service experience good quality outcomes in this area. The registered manager is taking positive steps to make the environment more interesting for those who live in it. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is situated close to local amenities, and is set in very pleasant surroundings. It is clean, and free from any unpleasant odours. The information provided by the registered manager before the site visit confirmed that it is kept maintained. The registered manager confirmed that the fire service has visited since the last key inspection. She confirmed that they were satisfied with the fire safety systems in place. Fire safety checks within the home were kept up to date. This helps to protect people from the risk from fire. The Environmental Health department have also made a recent routine visit to inspect the kitchen area. The registered manager has just received the report, Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 21 and is taking action to make sure that any requirements and recommendations made are met. This will make sure that the food service area of the home is properly and safely managed. The communal area on the first floor has been decorated. This makes it more pleasant for people. Although further thought needs to be given to this area, ornaments and additional pictures now provide some relief in the first steps towards making the environment more interesting for people. People’s bedrooms can be decorated with their personal belongings, and people can have their picture on their bedroom door. This helps to make the room more homely and easily recognisable for the person concerned. The laundry is separate from the living areas. Washing machines have a sluice facility so that soiled clothing can be washed at a suitable temperature. The laundress is provided with protective gloves. Staff receive training in infection control. This will help to reduce the risk to people from cross infection. Everyone has their own clothes, which looked nicely laundered. People were assisted by staff to change when this was necessary. This helps maintain people’s dignity. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 22 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 People who use the service experience adequate quality outcomes in this area. Extra attention to the recruitment, induction and training programme would ensure that people are always looked after by staff who are fit to care for vulnerable people. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Cleaning, laundry and maintenance staff are available in addition to care staff. On the day of the site visit, there was an unavoidable shortfall in the number of staff available, because of short notice sickness. The registered manager had made every effort to employ agency staff. Whilst normally working supernumerary, she made herself available, and rearranged her programme, so that people could continue to receive the personal care that they needed. It was recognised that the lack of staff contributed to the lack of activities provided on the day of the site visit, in exceptional circumstances. Although staff spoken with agreed that, whilst there were normally sufficient of them available to provide care, sometimes the time that they have to spend with people socially is limited. Two recruitment files identified that both care staff had started work after the registered manager had carried out a POVAFirst check, which informs her whether the staff are suitable to work with vulnerable adults, but before the full Criminal Records Bureau police check was returned. Whilst she gave assurance that the staff had been supervised, she had not obtained two written Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 23 references, having relied on one written and one verbal reply. A verbal reference is not robust enough evidence to rely upon when deciding whether staff are suitable to work with vulnerable people. As such, people must only commence employment after two written references have been obtained. At the thematic inspection, it was highlighted that staff do not always complete their induction period when they are first employed at the home. This means that discussion about privacy and dignity is not always covered, nor are the detailed policies available at the home read and signed. However, the registered manager, who agreed that this was the case, has not had the opportunity to induct any new members of staff since. She has however given assurance that this will be completed in the future. Staff are encouraged to work towards National Vocational Qualifications in care. Some care staff have qualified overseas as registered nurses, and so are assessed as having equivalent skills in caring for people. In addition to this, staff receive other training to help them give care in a safe and consistent way. This includes mandatory training, and also some training in dementia care. The registered manager intends to source distance learning in dementia awareness for staff, so that they can have a better understanding about the condition. She is also sourcing training for staff specifically about privacy and dignity. This would be good practice, because it would help staff to have a more in depth understanding of the needs of people with dementia, and the associated problems that they may encounter as part of their condition. There have been some changes to the areas in which staff work. The registered manager should check with the appropriate agency whether the recently appointed chef needs to complete any further training in the area of catering to meet the needs of the service. A professional visitor to the home thought that staff always have the right skills and experience to support people. Visitors on the day said that staff were ‘good’, and a person living at the home though that all the staff were ‘nice’. Comments made before the site visit included that staff ‘show affection and concern and as much understanding as possible’, and five out of six relatives thought that staff either always or usually have the right skills or experience to look after people properly. One isolated comment was made which suggested that staff are not guided on how to give care to people. They perceived that for some staff the provision of care seemed to be a ‘chore’. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 24 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): 31,33,35 and 38 People who use the service experience adequate quality outcomes in this area. Although the home is run by a well qualified individual, the systems in place to make sure that the home runs in a proactive, inclusive and safe way, need to be strengthened and built upon. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager is well qualified in the field of mental health. She is a Registered Mental Nurse, has a degree in mental health, and she and the deputy manager have recently completed the Registered Manager Award. This experience and knowledge gives her a distinct advantage when managing Sycamore Hall, when working towards achieving good outcomes for people who live there. Staff spoke very positively about her. They said that she was an ‘excellent manager’, very good’, with an ‘open door policy’. She receives support and guidance from the area manager, who carries out regular visits to the home to check that it is running smoothly. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 25 The company has developed a quality assurance system, which seeks the views of people who live at the service where possible, and their relatives. They are looking at how visiting professionals’ views can also be collected and taken into account when deciding how the home should be run in the best interests of the people who live there. The registered manager said that the latest survey identified that staff needed to pay more attention to making sure that people were not left with food on their clothes after meals, and that staff should spend more time talking to people rather than to each other. The registered manager stated that these issues have been addressed through a ‘handover report’, but that nothing formal has been recorded about what action has been taken. The registered manager explained that people normally get a newsletter, and relative meetings are normally held every three months, although she said that these had not been distributed or held for some time. The registered manager should consider providing written feedback as to how she intends to address matters raised, and reinstating the newsletters and meetings as a priority, so that people can see that their views are being taken seriously. Improvement in this area would make a positive difference to people’s inclusion in the way that the home is run. The home does not manage anyone’s personal allowance. The information received before the site visit confirmed that the home is kept maintained. A sample of certificates seen on the day confirmed that this was the case, although the company must check to make sure that the recent service of the gas systems included a check of the gas appliances, as well as the boilers. In house safety checks are also carried out. For instance, bed safety rails are checked to make sure that they are safely fitted, the fire alarm system is checked weekly to make sure that it will work properly in the case of fire, and hot water temperatures accessible to people living at the home are checked monthly. This will help reduce the risk from scalds. Because the most recent recorded check of the hot water had gone missing, the registered manager had been instructed by the operations director on the day of the site visit to photocopy a previous checklist, on which the date was altered. The aim of the document is to check and record that people are being protected from excessive hot water, which could cause scalding. It is not acceptable that documentation should be altered in this way purely to satisfy the purpose of the inspection. Staff receive mandatory training in fire safety, infection control, moving and handling, food hygiene and first aid. It was identified from discussion with staff and from the staff matrix that some staff training may need to be updated. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 26 In addition, some staff moved people in an unsafe way. The registered manager must take steps forthwith to make sure that people are moved safely. In addition, the company should look at the training provided to staff to see whether it is satisfactory. The registered manager was satisfied that there is always a qualified first aider on duty. She should devise a system so that staff know who this person is on each shift, so that they know who to go to in an emergency. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 27 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A X X 1 Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 Requirement Timescale for action 12/12/07 2 3 OP38 13 13 OP38 In the exceptional circumstance where staff have been employed after receipt of a POVAFirst check, but before their Criminal Records Bureau check has been returned, two written references must always be obtained, so that sufficient evidence is seen to make sure that the person to be employed is suitable to work with vulnerable people. To avoid unnecessary danger to 12/12/07 them, people must be moved safely at all times. The moving and handling 31/01/08 training provided to staff must be reviewed, to make sure that it gives staff proper instruction about how to move and handle people in a safe way. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 29 No. 1 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should refer to the training that staff are given to assist them in meeting the needs of people with dementia. It should also explain how the specific needs of people with dementia are met. This will inform people about the resources available, and the skills that staff have to help them provide good care for people with dementia. To help uphold people’s individuality, their care plans should include more information about their individual social, emotional and recreational needs, personal wishes and areas of strength and ability. Checks made to assess people’s current health needs should be more closely linked to the risk assessments and care plan. This will mean that risks to their health that have been identified can be discussed and reviewed with the appropriate professionals at the earliest point where this is deemed necessary. So that the situation can be properly monitored, when a person is identified through their assessment as being at high risk from pressure sores, the reasons why preventative action is not taken to reduce the risk should always be recorded in the care plan. To assure people that staff are properly trained, and to minimise the possibility of avoidable error, the registered manager should check that the training that staff receive in the safe handling of medication is sufficient, and should organise additional training where it is not. Staff should treat people in such a way which makes them feel included, and which upholds their rights to respect and dignity at all times. To help make people’s lives more interesting and socially fulfilled, the company should give serious consideration to the provision of additional activities for them. Staff should endeavour to make the mealtime a more social occasion for people who live at the home. Staff attitude and preferred routine should never take precedence over the rights of people to make choices about their daily lives. Care staff should be provided with training in privacy and dignity and dementia care, and should complete their induction. This should include reading and signing the policies and procedures relating to privacy and dignity so people can be sure that they are clear about the aims and objectives of the home in the provision of person centred DS0000065290.V353411.R03.S.doc Version 5.2 Page 30 2 OP7 3 OP8 4 OP9 5 6 OP10 OP12 7 8 OP14 OP30 Sycamore Hall Care Home care. Advice should be sought from the appropriate professional body to check whether the chef requires additional training to assist them in their work, and action taken where this is needed. Relatives meetings should be reinstated, and written feedback should be provided about what action has been taken following the results of satisfaction surveys, so people can see that their views are being considered in the way that the home is run. To assist good working practice, an audit of the training that staff have completed should be carried out to make sure that all staff are up to date with their training, and that provision has been made to update this where they are not. So that the right attention is available without unnecessary delay in the case of an emergency, a system should be devised so that staff know who is the first aider to go to in the case of an emergency on their span of duty. 9 OP33 10 OP38 Sycamore Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 31 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Hall Care Home DS0000065290.V353411.R03.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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