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Inspection on 23/10/09 for Sycamore Hall Care Home

Also see our care home review for Sycamore Hall Care Home for more information

This inspection was carried out on 23rd October 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager had acted promptly to the immediate requirement notice that was left at the end of the first day`s inspection. After the inspection the manager wrote to us and told us how staff were to be deployed and what measures she had taken to make sure that there was enough staff on duty and that if any member of staff on duty was from an agency then they would work alongside a permanent member of the staff team. Nigel Young the operations manager told us that staffing levels on the upper floor had been increased to three trained nurses, and six care assistants during the day and two trained nurses, and three care assistants on duty during the night . On the residential unit which is on the ground floor we were told that during the day there was one senior care assistant and four care assistants on duty, and on a night time one senior care assistant and one care assistant. We were also told that one additional member of staff is to be on duty from 08:00 to 14:00hrs every day to focus on residents having food and drinks served to them.

What the care home could do better:

We had serious concerns about the competency of some of the trained nurses on duty, who demonstrated they had very little insight into the way in which people should be supported and cared for. We saw that some people were not being supervised properly and that they were being placed at risk of harm because of this. We observed some institutional practices that demonstrated a lack of understanding from the staff who were employed at the home. We also heard some abusive language being used by a member of staff to another member of staff in relation to a service user. Despite agency staff being given an induction to the home it was very basic and did not focus on what was expected of them in relation to caring and supporting people. This coupled with poor deployment of staff and lack of effective management indicates that people`s health safety and welfare is being put at unnecessary risk.The majority of the care plans we looked at were still lacking in detail and staff were not clear about the care they should be given to people. Nigel Young told us that `pen pictures` had been completed on six people. These were `a starting point for the care plans to be developed`. The pen pictures were also lacking in instructions and the few plans that had been developed were also poor. Some risk assessments had been completed in the pen pictures however there was no clear instruction for staff to follow that would ensure the identified risk was eliminated or managed to minimize the risk. We observed people over the lunchtime period in the dining area on the upper floor. It was chaotic. People`s nutritional needs are not being addressed properly. Some people were assessed in their care plans as at risk of weight loss. There was no system in place to ensure they received a fortified diet. People were left for long periods of time sat at the dining table waiting for assistance. We observed one person who was being assisted by a nurse to eat lunch. The nurse was sat beside this person using a desert spoon to feed this person, and offering juice out of a spouted beaker. The nurse did not speak but quickly spooned the food into the person`s mouth. The person was not interested in eating and was falling asleep. We looked at this person`s care plan, a speech and language therapist had made recommendations regarding how this person should be supported with meals. It said that food should be given slowly from a teaspoon and that fluids should be thickened, neither was observed to have been carried out at this inspection. We saw that people`s privacy and dignity was not always respected by some staff. A trained nurse was rearranging someone`s catheter bag in the communal lounge area with other service users and visitors to the home watching. One resident was found by the inspectors on three occasions to be undressed in a communal area of the home, on one occasion staff were stood beside this person having a conversation and ignored this behaviour until the inspector asked for some assistance on behalf of the person. We found that people were in receipt of medication that was not currently prescribed for them, but the nurses had continued to administer it. Although we did not see staff conceal medication in food and drinks, we saw two tablet crushers that had been used and left dirty in the first floor communal dining room after lunch. We found that there is not enough equipment and aids to meet people`s assessed needs. On the first floor staff told the inspector that they only had one hoist to use and people had to wait a long time sat in wheelchairs to be transferred to a more comfortable chair. We were also told that they have only one padded sling and one toileting sling for everyone to use. We found recording in peoples care plans that highlights the need for specialist beds but that people were still waiting for this equipment several months after this need has been identified. We did not see any evidence of plate guards or adapted cutlery in use at mealtimes, staff said they did not have any to give people. We did not see any pressure floor mats being used or any other alternative to bed rails used if risk assessment identified that bed rails were not suitable. It appeared that the only alternative staff used was to place someone on a mattress on the floor to sleep on. We inspected a persons care plan and read that an accident had occurred there was no reference to this in the taking place in the accident recording book. We asked the operations manager about this. He went and spoke to the member of staff who had documented it in the care plan to ask if a record had been made elsewhere. Upon his return he said that the nurse `can clearly remember the accident , but for some reason had not recorded it in the accident book`. From the record in the care plan it was unclear if this person needed further observations, medical intervention or what measures hadbeen taken if any to minimize the risk of the accident occurring again. C

Random inspection report Care homes for older people Name: Address: Sycamore Hall Care Home Kearsley Road Ripon North Yorkshire HG4 2SG two star good service 09/12/2008 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Bridgit Stockton Date: 2 6 1 0 2 0 0 9 Information about the care home Name of care home: Address: Sycamore Hall Care Home Kearsley Road Ripon North Yorkshire HG4 2SG 01765606025 01765609437 liz@premiernursinghomes.com 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) : Premier Nursing Homes Limited care home 62 Number of places (if applicable): Under 65 Over 65 62 dementia Conditions of registration: Date of last inspection Brief description of the care home 6 0 9 1 2 2 0 0 8 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 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 Care Homes for Older People Page 2 of 12 Brief description of the care home for those who wish to look at it. The fees range from £400.36 to £758 .00 per week. Care Homes for Older People Page 3 of 12 What we found: We did a key inspection of Sycamore Hall Care Home on the 7th October 2009. Following this inspection we received some more information that gave us concern and we decided to carry out another inspection to make sure that people were being cared for properly and that they were safe. When we arrived the manager for the home and the operations manager for the company were on duty. We did this inspection using our power to seize documents that we may use as evidence if we need to take any further action if the home does not do what we ask of them. This is in relation to making sure that the home operates properly and that people are looked after and cared for safely. We also gathered other information by talking with the people who live at Sycamore Hall, their relatives and the staff who were on duty at the time of the inspections. In addition we also looked at some other documents and observed how staff support and care for people. At the end of the first day of the inspection we issued an immediate requirement notice because we had concerns about the competency of some staff on duty at the home, and how some people were being cared for. What the care home does well: What they could do better: We had serious concerns about the competency of some of the trained nurses on duty, who demonstrated they had very little insight into the way in which people should be supported and cared for. We saw that some people were not being supervised properly and that they were being placed at risk of harm because of this. We observed some institutional practices that demonstrated a lack of understanding from the staff who were employed at the home. We also heard some abusive language being used by a member of staff to another member of staff in relation to a service user. Despite agency staff being given an induction to the home it was very basic and did not focus on what was expected of them in relation to caring and supporting people. This coupled with poor deployment of staff and lack of effective management indicates that peoples health safety and welfare is being put at unnecessary risk. Care Homes for Older People Page 4 of 12 The majority of the care plans we looked at were still lacking in detail and staff were not clear about the care they should be given to people. Nigel Young told us that pen pictures had been completed on six people. These were a starting point for the care plans to be developed. The pen pictures were also lacking in instructions and the few plans that had been developed were also poor. Some risk assessments had been completed in the pen pictures however there was no clear instruction for staff to follow that would ensure the identified risk was eliminated or managed to minimize the risk. We observed people over the lunchtime period in the dining area on the upper floor. It was chaotic. Peoples nutritional needs are not being addressed properly. Some people were assessed in their care plans as at risk of weight loss. There was no system in place to ensure they received a fortified diet. People were left for long periods of time sat at the dining table waiting for assistance. We observed one person who was being assisted by a nurse to eat lunch. The nurse was sat beside this person using a desert spoon to feed this person, and offering juice out of a spouted beaker. The nurse did not speak but quickly spooned the food into the persons mouth. The person was not interested in eating and was falling asleep. We looked at this persons care plan, a speech and language therapist had made recommendations regarding how this person should be supported with meals. It said that food should be given slowly from a teaspoon and that fluids should be thickened, neither was observed to have been carried out at this inspection. We saw that peoples privacy and dignity was not always respected by some staff. A trained nurse was rearranging someones catheter bag in the communal lounge area with other service users and visitors to the home watching. One resident was found by the inspectors on three occasions to be undressed in a communal area of the home, on one occasion staff were stood beside this person having a conversation and ignored this behaviour until the inspector asked for some assistance on behalf of the person. We found that people were in receipt of medication that was not currently prescribed for them, but the nurses had continued to administer it. Although we did not see staff conceal medication in food and drinks, we saw two tablet crushers that had been used and left dirty in the first floor communal dining room after lunch. We found that there is not enough equipment and aids to meet peoples assessed needs. On the first floor staff told the inspector that they only had one hoist to use and people had to wait a long time sat in wheelchairs to be transferred to a more comfortable chair. We were also told that they have only one padded sling and one toileting sling for everyone to use. We found recording in peoples care plans that highlights the need for specialist beds but that people were still waiting for this equipment several months after this need has been identified. We did not see any evidence of plate guards or adapted cutlery in use at mealtimes, staff said they did not have any to give people. We did not see any pressure floor mats being used or any other alternative to bed rails used if risk assessment identified that bed rails were not suitable. It appeared that the only alternative staff used was to place someone on a mattress on the floor to sleep on. We inspected a persons care plan and read that an accident had occurred there was no reference to this in the taking place in the accident recording book. We asked the operations manager about this. He went and spoke to the member of staff who had documented it in the care plan to ask if a record had been made elsewhere. Upon his return he said that the nurse can clearly remember the accident , but for some reason had not recorded it in the accident book. From the record in the care plan it was unclear if this person needed further observations, medical intervention or what measures had Care Homes for Older People Page 5 of 12 been taken if any to minimize the risk of the accident occurring again. Compliance by the registered provider with the requirements made at this inspection and the previous inspection of the 7th October 2009 will be closely monitored. 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 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 27 18 There must be qualified 26/10/2009 competent and experienced staff on duty who know how to met the individuals needs including the right to dignity. In order that peoples health safety and welfare is protected at all times. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 12 Specific instructions following 02/12/2009 a specialist health assessment must be carried out and adhered to by all staff. This will make sure the persons health, welfare and safety is maintained and not jeopardized by staff who are not following instructions. 2 9 13 People should only received medication that is currently prescribed for them and is written on a current medication administration record. This will make sure people are in receipt of the right prescribed medication. 02/12/2009 Care Homes for Older People Page 8 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 3 10 12 All personal care should be delivered in private. This will make sure that peoples right to privercy and dignity is upheld. 02/12/2009 4 12 13 If a person is assessed as 02/12/2009 requiring equiptment such as a specialist nursing bed, then it should be provided promptly. This will make sure people are not put at risk of harm by staff not having suitable equiptment to use. 5 15 12 Arrangements must be put 02/12/2009 into place to ensure that staff support and assist all service users with their food intake. This will make sure that people receive a nutritious and where required fortified diet that is appropriate to their individual assessed needs. 6 27 19 Agency staff must be given a 02/12/2009 thorough induction to the home. This must include details of how they are to meet peoples assessed care needs. This will make sure that people are cared for by staff who are fully informed of the persons assessed needs and what care is to be provided in order that these needs are Care Homes for Older People Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 met. 7 27 18 The registered person must ensure that staff are appropriately deployed and supervised throughout each shift. This will make sure that people are being cared for appropriately and their health and safety is not put at risk. 8 31 12 The home must be conducted and managed so as to promote and ensure the health and welfare of service users. This will make sure that staff know what is expected from them and people living at the home at not put at risk through ignorance. 9 37 17 A record of food provided for 02/12/2009 service users must be maintained and include sufficient detail to demonstrate whether the diet is satisfactory. This will make sure people are in receipt of sufficient food and drinks in order to maintain an adequate intake throughout a twenty four hour period. 10 38 13 All accidents must be 02/12/2009 recorded properly and in sufficient detail within the homes accident record book. 02/12/2009 02/12/2009 Care Homes for Older People Page 10 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 So people involved in the accident are in receipt of the correct care and support to keep them safe. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Where the covert use of medication has been agreed by the multi-disciplinary team involved in someones care, a detailed care plan setting out when medication should be given covertly and how this should be done should be put in place. For example, confirmation that the medication can be crushed or supplied in liquid form and information about any foods or drinks that the medication can not be mixed with safely. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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