Inspection on 09/01/07 for Sycamore Hall Care Home

This inspection was carried out on 9th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 12/12/07

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 John McGarva Key Unannounced Inspection 9th January 2007 10:00 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.V326366.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sycamore Hall Care Home DS0000065290.V326366.R01.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.V326366.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: Sycamore Hall is a new care home providing nursing and personal care for up to 62 people who are over 65 yrs and 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. Additionally, up to 6 people suffering from dementia below 65 yrs of age can be accommodated in either unit. 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 in red brick and on two floors, including ground floor and there is a vertical lift providing level access to the first floor. The front elevation faces east, in front of which car parking is provided. There are landscaped areas to both sides and two enclosed, part paved garden areas at the rear west facing aspect of the home. The pre-inspection questionnaire (PIQ) submitted by the home dated 19-08-06 indicated that the fees charged are £450 - £525 per week. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report relates to the unannounced inspection, which took place on Tuesday 9th January 2007, and the manager Mrs Elizabeth Corser was available to assist with the process. The home has new owners and the change appears to have been effected with minimal disturbance as far as the staff and residents are concerned. The inspection started at 10.00hrs and finished at 15.30 hrs, a total of 5.5hrs. The home had 31 residents on the first floor and 29 on the ground floor residential unit. The inspection focused on the key standards, and matters raised at the last inspection. An inspection of some of the residents’ rooms, lounges, bathrooms and kitchen also took place. Discussions took place with the manager, nurses, and care staff. The residents in both residential and nursing units appeared content and well presented and none were distressed or noisy, which can occur in this client group on occasions. What the service does well: The manager has managed to establish the home, which was only opened in September 2005 and is providing good care for population of sometimes severely confused and challenging residents. Her relationship with the staff appears good and further management inputs such as regular meetings with the staff have now been established. The staff speak well of the manager and believe she is approachable and ‘a good leader’. The assessment and care plan documentation is of a good standard and is the foundation of which the care can be delivered. Conversations with the nursing and care staff were very revealing with evident strong commitment by them to provide for the best possible outcomes for the residents. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 be made available in other formats on request. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 7 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.V326366.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s needs are sufficiently assessed thereby providing the foundation on which the care plans can be developed. EVIDENCE: Evidence from the case tracked residents records confirmed that pre-admission assessment sheets are completed prior to admission. The manager or undertakes these either in hospital or the resident’s place of residence prior to admission. This assessment forms the initial basis of the care plan and where Social Services are involved, a copy of a care plan from a care manager may also be available prior to admission. Intermediate Care (Standard 6) is not provided in this home. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good standard of care is being provided by staff that is well-motivated. EVIDENCE: Individual ring folders are available for each of the home’s residents into which all information relating to their care plan and needs are kept. The care staff on the ground floor residential unit is involved in the documentation of the residents care on a daily basis. Only the nurses are involved in the documentation of care on the first floor nursing unit. All the people who deliver the episodes of care should record it and this was discussed with the manager. The care plans are specific to the individual resident and identify all pertinent issues, which helps ensure that all health and social needs are met. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 10 The timings of the daily statements are more frequently being recorded utilising the 24hr clock. The resident’s dignity is respected in so far as the staff was seen to be knocking on doors before entering and care staffs exchanges with the residents was observed to be respectful and positive. The residents looked well cared for and although unable to express a view of their care due to their debility there were none who were noisy or displaying any symptoms of distress or discomfort. The dependency of many of the residents is very high with many being doubly incontinent. Thirty-five residents require assistance with their feeding, washing and bathing. The storage and administration of medications is managed in accordance with good practice. A 28-day blister pack system provided by a major pharmacy provider is in use and the provider also delivers three-day medication management courses on site for the care staff. The nurses administer the medications on the first floor nursing unit and NVQ Level 2 or 3-trained care staff administers the medications in the residential unit. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines as much as possible help the residents to have control over their own lives. More activities organiser hours would help ensure that their social needs are met. EVIDENCE: The home has recruited an activities organiser for 16 hrs per week, but who is soon to go on maternity leave. However the manager is planning to fill the vacancy when this takes place. More hours are indicated as the care staff do not have much time over and above addressing the residents basic care needs. Visiting arrangements are flexible so that the residents are able to see relatives and friends whenever they wish. From the observations and discussion with the staff it seems that the the food provided is of good quality and there is a heated bain marie which delivers the meals to the first floor nursing unit. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 12 The lunchtime meal on the day of inspection was very tasty and included fresh vegetables and freshly made steamed pudding. Many of the residents require assistance with eating. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a relevant complaints procedure and the staff has received abuse awareness training. EVIDENCE: The complaints procedure of the home meets the required standard. The care staffs are aware of how to respond to any complaints made by either the residents or their representatives. Staff spoken to had received training in adult abuse issues and knew how to recognise and respond to this should it occur. There have been no complaints made about the home in recent times. The resident’s relatives and friends are made aware of how to access advocacy groups and other avenues for their rights to be exercised and protected. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environmental standards of the home are good. The provision of modern Moving & Handling equipment should be considered. EVIDENCE: This home has been open since September 2005. It has been refurbished to a good standard with the furniture and fittings in good order and the decorations are pleasant, light, and free from any superficial damage. The home now has their own handyman and access to a decorator that is shared from another home in the group based in Northallerton. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 15 Each resident’s individual room has a lockable door and drawer provided so that they or their relative or friends can secure their valuables in a dignified way. The grounds are well laid out and there are two enclosed garden areas at the rear so that the residents can wonder in safety. There is adequate sitting, recreational and dining space provided. The lighting is in all areas satisfactory and each resident has bedside lighting provided. All bathrooms and toilets are clearly identified. There are two assisted baths and two assisted shower rooms provided on each of the floors of the home. There is a ‘rising chair’ water pressure lift fitted to one bath on each of the floors of the home. Kneel pads have now been provided for the staff to use when bathing in the low-set baths. A basic hydraulic ‘ pull lever ’ hoist is provided on the first floor nursing unit to aid transfer of the residents onto the ‘rising bath chair’. The care staff really appreciate the provision of the new power assisted ‘Standaid’ on the first floor nursing unit as it enables them to more easily effect the safe transfer of the residents from armchairs to chairs etc. Additional power assisted mobile hoists would also help them in their work and they hope that they will also be provided soon. There are no hoists provided at all on the ground floor residential unit and it is not clear how residents are managed should they fall to the floor. There are grab rails provided in corridors and provision in the toilets, and provision of these in bathrooms and shower rooms are now in process. A hard-wired nurse call system is provided in all rooms, bathrooms, toilets and communal rooms and cancellation must take place at the actuation point. The resident’s bedrooms are all single, have en suite toilet and apart from five rooms, all have shower facilities also provided. The care staff said that as most of the rooms have their own showers the resident’s preferred to use them rather than the communal bathrooms or showers. There are only four adjustable-height beds provided in the home for nursing cases on the first floor. Additional beds of this quality are to be provided on an incremental basis. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 16 The divan beds on the ground floor (residential unit) are set low to the floor and in consequence can impede the resident’s ability to get in and out of bed and also put strain on the backs of the care staff. The home is well provided with good quality heating and low surface temperature radiators are provided throughout to provide a safe environment. All the hot water outlets deliver water at temperature no greater than 43°C and these are tested on a monthly basis and records kept. Emergency lighting is provided throughout the home. There are appropriate policies and procedures in place to reduce the risk of cross infection. Liquid soap and disposable towels in dispensers are provided in all the residents rooms, Bathrooms, toilets, medication room, laundry, kitchen and sluice rooms, thereby helping reduce the incidence of cross infection. The premises are clean and hygienic and were free from any offensive odours on the day of inspection There is a sluice room with a commode pan disinfector on each of the two floors of the home although commodes are not routinely used in the home. The laundry, which is located on the first floor above the kitchens, is well appointed and has two washing machines with sluice cycles and two gas driers. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory recruitment practices are followed. There is sufficient staff to provide personal care. EVIDENCE: Recruitment of staff continues to be a challenge for the home as there are many homes in Ripon and some of the care staff is from other countries, Philippines, China and South Africa, which can make communication difficult on occasions. All the nursing and care staff spoken to on the day of inspection were fluent and coherent in their language. The numbers of staff employed appears to be sufficient but the care staff felt they were struggling to meet everyone’s needs on occasions. The exchanges between the nursing and care staff and the inspector were entirely positive with the staff demonstrating keen commitment to the quality outcomes for the residents. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 18 Thirteen of the twenty-five care staff has been trained to NVQ Level 2 standard representing 52 of the total thereby meeting the 50 standard in this regard. The recruitment procedures at the home meet the required standard and all Criminal Record Bureau (CRB) checks have been done for all staff. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by a manager who enjoys the support and confidence of the staff. Improvements in the provision of Moving & Handling equipment are indicated. EVIDENCE: The manager is a Registered Mental Nurse (RMN) who also a degree in mental health nursing. She has many years of experience in caring for the elderly who suffer from dementia. The manager, together with the deputy manager has commenced the training required for the NVQ Level 4 Management award. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 20 She has an ‘open door’ policy so that staff can come to see her on any matter of concern at any time. Staff spoken to said ‘she was a good leader, very good’. Regular meetings are now held with staff and relatives and this helps ensure that their views are expressed when changes are proposed. Formal Supervision for care staff is in place and this helps ensure that their training and development needs are identified and addressed. The care plans and other relevant documentation are kept in the office areas in secure conditions. The care staff confirmed that they had received training in Fire Safety, Moving & Handling Health & Safety, First–aid, Food hygiene, Abuse awareness, Challenging behaviour and Dementia care. More up-to-date power assisted hoists are required to help ensure safe practice as the present ‘pump-up’ hoists cause strain to the shoulder joints of the care staff. ‘Stand-aid’ and hoisting equipment should be provided on the ground floor residential unit. Regular servicing and records of this are maintained of the gas boilers, lift, and other equipment. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 3 3 Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations All the care staff should be recording their observations and care input in the resident’s records. The timings made of daily statements should always be recorded utilising the 24 hr clock. 2 3 OP12 OP22 More hours for activities person should be considered. Power assisted mobile hoists should be provided for both the ground floor residential unit and the nursing unit upstairs. A power assisted ‘Stand-aid’ should be provided for the ground floor residential unit to help ensure safe practice when transferring residents between surfaces. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 23 3 OP24 The problem of the low divan beds in the ground floor residential unit should be addressed. More height adjustable beds should be provided for the first floor nursing unit. Sycamore Hall Care Home DS0000065290.V326366.R01.S.doc Version 5.2 Page 24 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. 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