Inspection on 07/10/09 for Sycamore Hall Care Home

This inspection was carried out on 7th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamore Hall Care Home 23/10/09

Sycamore Hall Care Home 09/12/08

Sycamore Hall Care Home 12/12/07

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 17/02/2010.

Key inspection report Care homes for older people Name: Address: Sycamore Hall Care Home Kearsley Road Ripon North Yorkshire HG4 2SG     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bridgit Stockton     Date: 0 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 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: Premier Nursing Homes Limited care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home 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 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 4 of 32 Over 65 62 6 0 9 1 2 2 0 0 8 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: The Care Quality Commission (CQC) inspects care homes to make sure the home is operating for the benefit and well being of the people who live there. More information about the inspection process can be found on our website www.cqc.org.uk. This inspection key inspection was carried because we had received some information about some care practices that we thought might be putting people who live at the home at unnecessary risk of harm. Three inspectors visited the home. The methods we used to gather information were conversations with the people who live at Sycamore Hall, their relatives, healthcare professionals and the staff who work at the home. We looked in detail at the care and records of six people, examined other records and looked around the home. Some care managers from North Yorkshire County Council were also present at the Care Homes for Older People Page 5 of 32 home carrying out reviews on people who they had placed at the home. This was done because they also had concerns about the care people were receiving at Sycamore Hall. The manager of Sycamore Hall Debra White and the operational manager for New Century Care Nigel Young were also available throughout the inspection and verbal feedback was given to Debra White at the end of the inspection and via a telephone call to Nigel Young the following day. During the inspection a special observation was carried out on the first floor of the home. The people who live on this floor have nursing needs as well as being diagnosed as having dementia. 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. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: People are not properly assessed before moving into the home, therefore there is no guarantee that the home has the resources available to meet peoples needs fully. The manager must assess people properly before they are admitted to the home and whenever possible new admissions should be discussed with care staff in order to make sure that they are fully up to date with what is required of them to meet the persons needs. The manager needs to look at everyones care plans and risk assessments to make sure that they give clear guidance and directions to care staff about meeting peoples needs safely in a managed way. Information about people must be accurate and up to date so people get the right care and support they need from staff. The medication recording and administration systems need to be improved, to make them accurate and to assist with the auditing of stock. Staff need further training to make sure they follow the homes homes policies and procedures, to ensure they know how to deal with peoples medication properly and safely. People should be treated with privacy and dignity and respect at all times. This will help make sure peoples rights, and individual choices are upheld. The manager must make sure the home has a robust safeguarding process for dealing with abuse. This will make sure people who use the service are safeguarded. All staff require training in this area. Staff should receive more training that equips them with the knowledge and skills to deliver a safe service that meets the specialist needs of the people who live at the home. This will make sure people are safe and individual needs are met. Some parts of the home were not clean and we have asked the manager of the home to carry out a deep and thorough clean of the communal areas and peoples bedrooms. The Care Quality Commission (CQC) should be notified more when there are significant events that affect the health and welfare of people who live at the home. This will make sure CQC receives appropriate information and can monitor the health and welfare of people who are living at the home. We have made some requirements and recommendations following this inspection. You can read these in the main part of this report. Care Homes for Older People Page 7 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 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 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are assessed prior to being admitted to the home there is no guarantee that the home will be able to meet these assessed needs fully. Evidence: The manager told us that she would visit people who have been referred to the home and carries out an assessment of need prior to admission. Information is also collected from other professionals, such as care managers and hospital staff. People and their relatives are offered the opportunity to look around the home if they wish before making a decision, and there is also a homes brochure and service user guide for people to refer to. At this inspection we looked at some assessment documentation completed by the home. None of the assessments had been completed in full with some areas in the assessment left blank. In addition, not every case file looked at contained pre assessment documentation. The manager told us that sometimes not all of the Care Homes for Older People Page 10 of 32 Evidence: information was available at this initial assessment and that as she had only been in post a matter of weeks and had not as yet had the opportunity to carry out a pre admission assessment herself. Staff said they sometimes would not be aware of a persons needs until after they had been admitted into the home and often it was trial and error until we get to know them. In the absence of this information staff are unsure of what care and support needs to be provided to people upon admission. Intermediate care is not provided at the home, so standard 6 is not applicable. Care Homes for Older People Page 11 of 32 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. Peoples health and welfare is put at significant risk due to the lack of detailed instruction in care plans and poor risk management documentation, resulting in peoples needs not being properly met and their dignity not being respected Evidence: We were told by the manager and the operational manager that some documentation in peoples care plans was not up to scratch but that they were both auditing the plans and working with staff in order to improve on care planning. We were told that we would probably only find two reasonably good ones on each floor. We were also told that training in completing care plan documentation had been planned for all trained nurses and senior care assistants to attend, in the coming weeks. We looked in detail at six care plans and random sampled some others. None of the care plans we looked at were written in sufficient detail to ensure that staff could meet peoples assessed needs fully. Assessments in care plans had not been reviewed regularly and risk assessments were not completed properly. Examples of poor recording in care records were seen such as assist during dressing and grooming and has bath or shower. There was no reference in any of the files about the social and psychological Care Homes for Older People Page 12 of 32 Evidence: needs of people. This is very poor given that all the people who live at the home suffer from a dementia type illness. In risk assessment documents we saw written entries that gave us concern, for example we read rolls on the floor, bruises and bangs head on the wall. Worryingly there was no further documentation available to describe what action if any staff had taken to prevent this happening, or how this risk had been managed in order to keep this person safe. We asked staff on duty what they had done in response to this, they said nothing or yes I knew that happened but its normally on nights. The manager was unaware of this situation until we drew her attention to it. Observations on the first floor identified that some staff did not always provide an explanation before they were going to provide people with assistance. For instance we saw one member of staff using a communal comb to attend to someones hair. They later returned to the person and applied a hair product. The person was clearly agitated by this but the member of staff continued without any explanation or reassurance. We also saw staff putting aprons/bibs on people before lunch 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 or explain to people that they were going to be transferred of moved to another position. We observed people being pulled backwards in wheel chairs, the foot rests were not in use and because of this peoples feet were dragged on the floor. Some staff were talking about personal care that was to be carried out on people in loud voices in the communal lounge area. They were seen to be looking in the direction of one gentleman and saying Ive changed his pad, hes dry. We found trolleys stored in bathrooms on both floors that contained communal toiletries, towels and face clothes. There were also communal tights, stockings, socks and net pants on the trolley as well as someones false teeth wrapped in a tissue. A member of care staff said that they had these supplies because sometimes the laundry was not put away and there was often nothing available for them to use in peoples bedrooms. We visited the laundry; the laundry assistant was not on duty. We were unable to tell from the piles of clothes on the floor laid over chairs or in linen sacks whether the clothes were dirty or clean. There were dirty used gloves on the window ledge, clothes in a bucket soaking and soiled laundry mixed in with table linen. A large basket was seen full of unlabelled underwear such as stockings and socks. Staff said it was usual practice to restock the trolleys with stockings from this basket. Both the manager and operational manager said they were shocked when they saw the laundry. The manager said it wasnt like this the other day staff said that the laundry situation was normal. Staff look after peoples medication on their behalf. The quantity of medication received into the home from the pharmacy is not recorded on the medication administration record making the auditing of medication difficult. We checked the amounts of tablets against some medication records and they did not tally. There were gaps in the record where staff had not signed to denote that a medication had been administered. We looked at how Care Homes for Older People Page 13 of 32 Evidence: controlled drugs are stored, recorded and administered. We found that on two occasions in the control drug register there was a signature of the person witnessing the drug administration but not a signature of the person who had actually given the medication, therefore we were unable to tell if the person had received the medication. We found prescribed creams and lotions in peoples bedrooms, the prescription labels had been removed from most of them. Upon checking the medication records of these people we saw that they were not actually prescribed this medication. We found in one person room a prescribed cream that belonged to another person. None of this medication was locked away. Given the diagnosis of the people who live at the home unless risk assessment suggests other wise all medication including cream and lotions should be locked away. Care Homes for Older People Page 14 of 32 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. People are not stimulated, and are bored. Staff do not engage with people or encourage people to make choices about how they spend their days. Evidence: The care plans do not 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. Very little information had been obtained from relatives or representatives on these matters if people do not have capacity to tell staff themselves what they want and how they want to be cared for. The mealtime on the ground floor was relaxed, and people were free to come and go from the dining area as they wished. One inspector observed the lunchtime period in this area. Mixed comments about the food provided were given one person said Its all mush, another said its alright. People were offered chicken, creamed potatoes and vegetables, followed by plum crumble and custard for desert. We asked the cook what alternative would be offered if you did not like the meal provided. We were told there is no choice if they dont like it they can have a sandwich. The lunchtime was also observed by an inspector in the upstairs floor. This was disorganized. Some people were brought to the table in a wheel chair and waited thirty five minutes before they were given anything to eat or drink. One person had their head on the table asleep for at least twenty minutes before staff Care Homes for Older People Page 15 of 32 Evidence: attended to them. The tables were not set, there were no condiments available and cutlery was given out with the meal. The cook told us that there were no special diets only soft and liquidised. When asked about people who needed a high calorific diet, enriched and fortified we were told that nothing gets fortified, the mash has cream in it thats it. We asked about people who might be diabetic. We were told that all desserts and sauces are made with diabetic sugar, so they are okay for everyone to eat. There was no evidence of any activities going on at the time of the site visit on either floor. People were either just wandering around, sat in the lounge or corridors or in their own rooms. One person said its boring, theres nothing doing here. Upstairs the majority of people were asleep in the chair, sat in front of the television. It was noted that people are left for long periods of time without any staff interaction and without any stimulation in the communal areas. Because of the lack of supervision inspectors saw people becoming increasingly agitated with one another and beginning to get confrontational with each other. One person began taking their clothes off and another person moved a lounge chair around the room. When a member of staff entered the communal area, they did not intervene or engage with these people, they were ignored. Care Homes for Older People Page 16 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not being protected and are put at significant risk of harm due to the lack of understanding of staff as to what constitutes abuse. 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. We had been informed about several concerns that had been raised by relatives surrounding the lack of care and support provided to people who live at the home. The manager and a senior member of the company have written in response to some of these concerns. Staff spoken with knew that they had a responsibility to pass on complaints to the manager for her attention. They also knew that they must pass on any matters where they thought that people living at the home were not being treated properly. However during the inspection we found documentation that suggested that some form of abuse and neglect had taken place. We also witnessed and read some institutional abusive practices taking place. For example we read in one persons file had to go to bed earlier shes been misbehaving a bit. We saw a person with a table placed in front of them whilst they were sat in a chair, the person was trying to get up from the chair but the table was being used as a form of restraint stopping this person from getting up. The manager was unaware of these situations and therefore safeguarding referrals to the local authority who investigate these matters had not been done. We asked the manager to do this as a matter of urgency. Care Homes for Older People Page 17 of 32 Evidence: The 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. Care Homes for Older People Page 18 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not live in a pleasant, clean or well maintained environment. Evidence: Communal areas of the home and some bedrooms smelt of urine. The smell in the main corridor as you entered the home was particularly offensive. We looked at most peoples bedrooms all the communal areas and assisted bathrooms. Some peoples bedrooms had been cleaned to a reasonable standard, but surfaces were still sticky and dusty. In some bedrooms that had been cleaned there was an underlying smell of stale urine. We found several en suite bathrooms that had dirty toilets. In one en suite a face cloth that was smeared with faeces had been left in the hand wash basin. The member of staff who was showing us around the home told us that it could have only been left there by a member of staff. The majority of peoples bedrooms had the nurse call bell cord missing. This means people could not summon help if they needed assistance. In several en suites the cord had been tied up out of reach. Some of the furnishings are in need of replacement. The covering on some lounge chairs is damaged, the draws in some bedside tables are missing or else they do not fit properly, and some of the bed linen and towels are worn and stained. We were told by staff that most people were showered in their own en suite; however some people who live at the home did not have a shower facility. We looked at the communal bathrooms and toilets. These had all been locked so people could not Care Homes for Older People Page 19 of 32 Evidence: independently use them, and had to find staff to open the doors to use the toilet. There was only one bathroom in the home that was found to be functional. All the other bathrooms were used as storage for trolleys, wheelchairs and old furniture. The corridors were sparsely decorated and the paint on the upstairs corridor hand rail was flaked and the previous paint colour showing through. In the downstairs corridor there was some loose wire hanging down from the ceiling and the ceiling had several holes in it, but these had not been repaired and repainted. We were told that not all staff had received training in the control of infection. As stated in the previous section under health and personal care the laundry in the home was dirty, and it was evident that basic infection control measures were not being followed. We saw wheelchairs that had dried on food on the seats, and faeces smeared on another seat. A plastic bag containing used incontinence products was left on the floor of a bathroom. And staff were seen to be using the same gloves and aprons and not changing them in between assisting people to the toilet and entering the communal lounge areas. The laundry was dirty with used gloves not being disposed of properly. soiled clothing was mix with table linen waiting to be washed. Care Homes for Older People Page 20 of 32 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are not supported by permanent, suitably trained or competent staff which has led to peoples needs sometimes not being properly met. Evidence: The manager and operational manager told us that at the moment the home was having to use a lot of agency staff. On the morning of the inspection a member of staff had not turned up to work from the agency. On duty in the upstairs unit was one registered nurse and 5 care staff and down stairs there was one senior care assistant and 3 members of care staff. The nurse on duty is also responsible for two people whose bedrooms are on the ground floor. We were told by the manager that they only have two trained nurses employed at the home, they are recruiting more staff but in the meantime agency staff are being used. The inspector who was carrying out the special observation in the upstairs lounge area said that there were several times during the morning when staff disappeared and people were left unsupervised. Over the lunchtime period the kitchen staff disappeared from the downstairs kitchen and people were left waiting for dessert to be served. Eventually a member of care staff served it, however some people had already left the dining room without having it, due to the wait. Later we found out that the kitchen staff had gone upstairs to serve lunch but had failed to return to the ground floor dining room to complete service. In the afternoon an inspector also sat in the first floor lounge area. People had been left for twenty five minutes before a member of staff came into the room to check on Care Homes for Older People Page 21 of 32 Evidence: people. During this time one person was undressing another person was standing in front of people trying to attract there their attention to start a conversation, another person was moving a lounge chair from one place to another and one other person was trying to climb out of a chair. We talked to staff on duty. They told us they were continually rushed and did not have time to do the nice things we want to do with people. Staff said that there was a shortage of nurses and that when an agency nurse was used they spent most of the time explaining to the nurse about routines and who people were. Some staff said they struggled to carry out their tasks because there is are not enough staff. The trained nurse on duty was behind with giving out the morning medication This was due to the agency nurse not turning up to work and also the nurse worked mainly night shifts so was not familiar with the day time routine. Staff told us they have not attended regular training. Some said they have not attended fire training. One staff said they have not done moving and handling training but carry out moving and handling tasks. A member of staff who had been employed at the home for three months said that she had started to complete an induction booklet and that she had been given some basic training when she first started which included fire procedures and moving and handling. The manager and acting manager said that they were aware that training had fallen behind but had planned training booked organised training for staff in food hygiene, moving and handling, first aid, protection of vulnerable people and care planning. Staff have not been given specialist training in caring for people who have dementia, but the manager and operational manger said that this was planned for later next year. Care Homes for Older People Page 22 of 32 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. Lack of leadership and a fragmented management team has led to some people being put at unnecessary risk and exposed to receiving a poor standard of care and service. Evidence: The manager at the home is newly appointed, although she has worked for the New Century Care Group, she has not worked at this home before. There were areas of serious concern highlighted to both the operational manger and the manager during and after the inspection. From our observations and speaking with the operational manager and manager it was clear that problems at the home had been identified, and that they have started to take action to put things right. Staff told us the operational manager and area manager had so far been very supportive. New Century Care has quality assurance manuals in place and audits have been completed by previous managers and the area manager. However, in light of the Care Homes for Older People Page 23 of 32 Evidence: findings at our inspection it is evident that the systems have not been effective. The home does not manage any financial affairs on behalf of people who live at Sycamore Hall. Although accidents are recorded, we did not see evidence that accidents and safeguarding incidents are being properly managed or followed through during care reviews. Because of poor documentation it is unclear whether people have received appropriate medical attention or appropriate action has been taken to prevent further accidents. The manager must now start to make significant improvements at the home in order to keep people safe and make sure their needs are fully met. We have already seen an improvement in the way we are notified about events that happen to people in the home that may affect their safety and well being. Care Homes for Older People Page 24 of 32 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 32 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 3 14 Peoples care needs must be 25/11/2009 properly assessed before they move into the home. This will make sure that the home has enough resources available to meet the persons needs fully 2 7 13 To avoid harm people who live at the home must have in place documented risk assessments and risk management plans To make sure that staff have clear instructions on how to manage an identified risk in order to keep people safe from harm. 25/11/2009 3 7 15 Each person must have a 25/11/2009 clear and detailed plan of care, giving instruction to staff on how assessed needs are to be met fully. To ensure that peoples care needs are met properly Care Homes for Older People Page 26 of 32 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 4 9 13 The receipt, administration 25/11/2009 and disposal of controlled drugs must be recorded in a controlled drugs register designed for the purpose. A signature in the controlled drug register is required of the person who administers the medication This will provide the extra security needed for this type of medicine and will help to prevent loss or diversion. Medication must be given as 25/11/2009 prescribed from a supply labelled by the pharmacy and a record must be made at the time that it is given. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. The use of communal clothing and toiletries must stop. This will ensure that peoples right to dignity is protected. 25/11/2009 5 9 13 6 10 13 7 10 12 People must be treated with privacy,respect and dignity at all times. 25/11/2009 Care Homes for Older People Page 27 of 32 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 This will help make sure peoples rights to privacy and dignity are maintained and protected. 8 15 12 A menu offering nutritious 25/11/2009 wholesome food should be offered, mealtimes should be unhurried and there needs to be sufficient staff on duty to assist people over the meal time periods. This will make sure people are given a choice of a nutritious well balanced diet, and that they are not waiting excessive lengths of time for assistance and support with their meals. 9 15 16 People who live at the home 25/11/2009 should be offered more daily activities. This will give people a more stimulating and fulfilling lifestyle 10 18 12 All staff who work at the 25/11/2009 home must be given training in the protection of vulnerable adults. To make sure people are safe and to protect people from harm 11 26 13 The areas of the home that were identified at the 25/11/2009 Care Homes for Older People Page 28 of 32 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 inspection that were dirty require cleaning. Carpets that were stained and smelling need to be either cleaned thoroughly or replaced. so that people live in a clean and comfortable home 12 26 13 The laundry needs to be clean and tidy. Systems need to be introduced so that cross contamination of dirty and clean laundry is avoided. This will make sure that the risk of cross infection is reduced and people are not put at unnecessary risk of infection 13 27 18 Skilled and competent staff 25/11/2009 must be on duty in sufficient numbers at all times To make sure peoples care needs can be met at all times by skilled and knowledgeable staff. 14 30 18 Training must be provided for all staff on a regular basis in order that people are trained to deliver care and support properly. The training should include the principles of care, safe working practice, the 25/11/2009 25/11/2009 Care Homes for Older People Page 29 of 32 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 organisation and worker role and the experiences and particular needs of the service user group. This will make sure people are in receipt of care from trained staff who are skilled in meeting peoples assessed care needs. 15 33 12 Quality audits that take place at the home must be more robust and effect change when people highlight dissatisfaction with the service. This will demonstrate that peoples views about the running of the home have been taken into consideration and people have a say in how the home is ran. 16 37 37 The Care Quality 25/11/2009 Commission (CQC) must be notified of significant events that affect the health and welfare of people who live at the home. This will make sure the regulatory authority receives appropriate information and can monitor the health and welfare of people who are living at the home 25/11/2009 Care Homes for Older People Page 30 of 32 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 17 38 13 Accidents that occur at the 25/11/2009 home must be recorded, any medical intervention resulting from an accident must also be clearly documented. This will make people safe and make sure they receive the proper medical care and intervention they require. 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 A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. It is recommended that a written record of all complaint outcomes is kept in accordance with the companies complaint proceedure. It is recommended that the manager makes an application with CQC to become the registered manager as soon as practicable. 2 16 3 31 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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