Inspection on 17/04/07 for Sycamore House

This inspection was carried out on 17th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sycamore House 16/04/09

Sycamore House 23/04/08

Sycamore House 21/11/07

Sycamore House 26/10/06

Sycamore House 15/06/06

Sycamore House 20/12/05

Sycamore House 21/07/05

Sycamore House 23/11/04

Sycamore House 29/04/04

Sycamore House 27/01/04

Sycamore House 16/12/03

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOMES FOR OLDER PEOPLE Sycamore House 2a/2b Havelock Road Tyseley Birmingham West Midlands B11 3RG Lead Inspector Kulwant Ghuman Key Unannounced Inspection 17th April 2007 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sycamore House DS0000016849.V334799.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 House DS0000016849.V334799.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore House Address 2a/2b Havelock Road Tyseley Birmingham West Midlands B11 3RG 0121 707 4622 0121 707 8172 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) Marblefield Limited Mr Abdool Azad Noorbaccus Care Home 30 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (30) of places Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the home is registered to provide care for up to 18 service users who are over 65 years of age and up to 12 service users who are over 53 years of age and who had a mental health disorder. Of the 18 service users over 65 years there are 5 named individuals who suffer from dementia and continue to be accommodated at Sycamore House until such time that the home is no longer suitable. No other service users suffering with dementia will be admitted to the home. The home may accommodate one named service user aged 48 years at time of admission who is suffering from enduring mental health issues. 26th October 2006 Date of last inspection Brief Description of the Service: Sycamore House offers residential care for up to 30 older adults. It caters for a mixed client group, including service users over 65 years of age in need of care due to old age and mental health. The home is not registered to admit further residents who suffer with dementia. The home has an owner manager who is a registered nurse, although the home does not offer nursing care. The home is situated in a residential street, close to public transport links to the city centre. There are some small local shops within walking distance. The property is an extended and converted building that offers communal lounges and dining space on the ground floor and bedrooms spread over the ground and first floors. No rooms are en-suite and bathing and toilet facilities are shared. The kitchen and laundry facilities are on the ground floor and are not generally accessed by service users. There is a shaft lift connecting ground and first floors on one side of the building only. There is a garden area to the side of the property and parking is on street. Current charges at the home range between £332 and £560 per week. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced key inspection over one day in April 2007. During the inspection the inspectors spoke with seven of the twenty-two residents, the manager and briefly to one member of staff. The care files of three residents and two staff were sampled along with other care and health and safety documents. No pre-inspection questionnaire or resident or relative surveys were sent out prior to this inspection. There had been no complaints about the service since the last key inspection. There were two issues of adult protection that were raised at the home. One was in respect of an incident between two residents and the other was in respect of a resident going missing from the home. What the service does well: What has improved since the last inspection? The home has put in place a ramp from the conservatory into the garden to allow safe access into the garden. Some progress had been made to the care plans however further improvements were required. A new cooker had been fitted in the kitchen. Intumescent strips had been fitted to fire doors in the main part of the home in compliance with the requirements of the West Midlands Fire Service. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 6 What they could do better: The management of the home needed to improve to ensure that the care plans and risk assessments were further improved to include details on how staff were to meet the residents needs in a safe way. The registered person needed to ensure that a master key was available to staff so that residents who wanted to lock the doors of their bedrooms could do so if they wanted. Privacy curtains and window dressings needed to be available where needed to ensure that the privacy and dignity of the residents were maintained. The management of medicines in the home was generally good however staff needed to ensure that all medicines were correctly booked into the home and balances were carried over from one month to the next. Where changes needed to be made to the prescribing instructions the changes needed to be verified by a second member of staff. The registered person needed to ensure that the social and recreational needs of all residents were met in a manner that was individual to each resident. The registered person needed to ensure that when incidents occurred that affected the well being of any of the residents the CSCI was informed at the earliest opportunity. The registered person needed to ensure that all new staff were appropriately inducted into the tasks to be undertaken in accordance with the Skills for Care competencies and that they were inducted into the needs and safekeeping of the residents. A training matrix needed to be set up to ensure that the training needs of staff could be identified and catered for. All staff must receive training in mandatory topics. Staff undertaking manual handling assessments must be competent to do so. The registered person must ensure that plans for a new registered manager and deputy manager are actioned as soon as possible to ensure the smooth running of the home and to ensure that the service improves significantly. The physical environment had further deteriorated and it was imperative that the refurbishment plans were progressed as soon as possible to ensure that the residents had a pleasant, homely and comfortable environment in which to live. Issues such as the restricting of hot water temperatures, infection control procedures and the removal of broken items of furniture and paving slabs in the garden area needed to be attended to. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 7 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 House DS0000016849.V334799.R01.S.doc Version 5.2 Page 8 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 House DS0000016849.V334799.R01.S.doc Version 5.2 Page 9 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): 2,3,4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s admission process does record a full assessment of the residents needs to ensure that their needs can be met at the home. Residents are given information about the home but contracts are not given at the point of admission to the home. EVIDENCE: The file of one recently admitted resident was sampled and showed that a preadmission assessment had been carried out before he was admitted to the home. There was no social work assessment available to the home and therefore a full, detailed assessment was needed to be undertaken by the home to ensure that they were fully aware of the residents needs. The assessment carried out by the home included some areas of need including mobility and a need for supervision with meals and personal care. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 10 The manager stated that a pre-admission visit had been offered but was refused. The manager informed the inspectors that the complaints leaflet and service user guide were given to the resident and his friend. There was no evidence available for this. The manager stated that no contract had been given to the resident as he was only there for a short period of respite. The resident had been living at the home for nearly two months and no contract was in place. It was important that a contract is given to residents on admission so that they are aware of the fees to be paid, who is to pay them, what services they can expect from the home and any conditions of residence in the home. There was no evidence of a 28-day review to ensure that the resident’s needs were being met. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning and risk assessments do not fully safeguard residents and ensure that their needs are met. Health care needs are generally well met but privacy and dignity in the home needed to be improved for some residents. EVIDENCE: Three residents files were sampled. New care plans have been introduced and were an improvement on previous plans in the home but the level of detail did not indicate the exact needs and how the staff were to meet these needs. One resident was fairly independent and the care plan though brief indicated that the staff were to prompt him with personal care. The plan did not identify that he was at risk of personal neglect, although the manager told the inspectors that this was the case, and therefore did not make the staff aware of what issues to look for and what actions to take if he was not compliant. Some risk assessments were not in place such as locking his door as there was Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 12 not a master key available in the home, or how to handle the situation when he was shouting. The records did not identify what the resident was shouting about. The second file was of a resident who had been at the home for some time and had specific health care issues to be managed. There were some generic guidelines on the management of this issue but there were no specific details on how this issue was to be managed for this resident apart from the medication that was being administered. There was evidence that mattresses were being used to prevent injury if the resident fell out of bed however this was not recorded in the care plan. The risk assessment for this issue stated that ‘all staff have been told what to do’. This information needed to be recorded so that all current staff and any new staff were aware of this information. During a tour of the building a cigarette end was found in the resident’s bed however there was no corresponding risk assessment for smoking for the resident. There was no evidence on the files that the residents or their representatives had been involved in drawing up or agreed with their care plans. Examination of the resident’s records indicated that the resident had been hospitalised following seizures twice during the past two months and on both occasions the resident had been dehydrated. The home needed to ensure that the resident was taking sufficient fluids. The third file was of a resident who had been in the home for some time. At the time of admission to the home the resident was using a zimmer frame but had improved and was walking with a walking stick. It was not evident from the file how the decision for him to use a walking stick was made, or whether there had been an assessment for the walking stick to ensure it was of the right height had been undertaken. The manual handling assessment stated that a member of staff and the resident had agreed for him to use the walking stick to ensure he did not fall. The manual handling assessments needed to be carried out by individuals who were experienced and competent to do so. Where residents have been identified as being at risk of falling the manual handling assessment must indicate how staff are to assist the resident. Risk assessments needed to be in place to manage any aggressive behaviours displayed by residents. There were nutritional assessments and pressure care assessments in place. The files also contained many blank sheets that were not applicable to the residents eg bed rail assessments. These sheets needed to be removed if they were not required. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 13 The health care needs of the residents appeared to be met. There were professional visitors sheets in place to ensure that health care needs could be tracked. It was not always possible to track the visits made by chiropodists or dentists to the home as they were not always being recorded on these sheets. The medication system appeared to be generally well managed. On the day of the inspection it was identified that the balances of boxed medicines being carried over form one month to the next were not always recorded. Due to this it was not possible to audit these medicines. Also some medicines had not been booked in when they were received into the home. The prescribing instructions for one resident were different on the MAR chart from those on the label on the box. Any discrepancies or changes to prescribing instructions needed to be countersigned by a second member of staff. One medicine should have been finished on the day of the inspection however there were two tablets remaining suggesting that the resident had not received the medicine as prescribed. Copies of prescriptions were kept on the residents’ care files. Two of the files sampled indicated that the residents were encouraged not to lock their bedroom doors by the staff. The manager stated that this was because the master keys had been lost. The home was planning to have the locks changed during the refurbishment programme. It was recommended that the manufacturer was contacted about a replacement master key as not having the key meant that residents’ choice was being restricted. Also, as identified by the manager, in the event of a fire it would be time consuming to unlock the doors with individual keys. Two of the shared rooms seen by the inspectors did not have appropriate privacy curtains in place and one of them did not have suitable window dressings up to provide privacy to the occupants of the bedroom. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of life for the residents was affected by how independent they were. The more able residents were able to access the community independently however this was not enabled for the less able residents by the home. Residents appeared to be satisfied with the meals provided in the home. EVIDENCE: The quality of daily lives for the residents varied a great deal depending on their level of dependence. There were some residents who were able to go out independently and did so on a regular basis to meet with family or friends. They were able to maintain contacts with the community independently. For residents who were dependent on the staff to meet their needs there was little socialisation and little evidence that their social needs were being actively met. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 15 The residents’ files indicated that residents were encouraged to attend communion in the home and that on occasions there were card games that residents were encouraged to play but only some residents took part in this. One resident’s file indicated that it ‘would be good if he went out with staff once or twice a week’. There was no evidence that this was happening. At the time of the inspectors’ arrival several of the more dependent residents were sitting in the lounge. One resident was looking at a newspaper and another was looking at the television and although in conversations did not seem to be able to understand what was on the television was watching it intently. The other two residents were sleeping in a slumped position over the side of their chairs. For these residents it appeared that the day was broken up with tasks such as meals or personal care. Organising of meaningful activities for the residents had been discussed with the manager on several occasions previously with little improvements being noted. The manager stated that the residents were not interested in getting involved in activities and it was difficult to take residents out due to staffing levels. Residents in the home had freedom of movement and were able to spend time in their bedrooms if they wished, sit in the lounge or conservatory which was the dedicated smoking area in the home. The residents were discouraged from using the second lounge at the time of the inspection as some new carpets were stored in there. Some residents’ choice to lock bedroom doors was being limited due to the lack of a master key to the locks. The manager told the inspectors that new meals from an outside organisation had been trialled for a week at the home but that they were not found to be suitable as the system did not allow for seconds to be offered. The home had reverted back to the original menus. At the time of introducing the new menus there was evidence that the residents had been asked about their preferences. It was recommended that some of these preferences needed to be introduced into a rolling menu system. Diabetic needs were provided for in the home. Mealtimes were not observed during this inspection however one resident stated ‘that they were having shepherds pie for lunch. This was not something they would have at home but you get used to it.’ Another resident said that the food was good and there was plenty of it. Some residents brought in takeaway meals for themselves and other residents who requested it. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 16 The meals for the day were not written up on the board in the dining room however, residents spoken with knew what the meal was going to be. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recent incidents indicate that residents are not safeguarded adequately and when incidents occur the appropriate procedures are not fully complied with. EVIDENCE: No complaints had been received about the home by CSCI. The registered person told the inspectors that no complaints had been received by the home. The staff had undertaken adult protection training but no details of what had been covered in the training sessions were available in the home. It was important for the registered person to know what areas had been covered in the training so that the staff’s use of the training in the home could be monitored. Two issues had occurred in the home since the last key inspection regarding the protection of residents. In one instance there had been an incident between two residents. The registered person had failed to fully comply with informing all the relevant authorities of the incident indicating a gap in the knowledge of the registered person regarding the adult protection procedures. The second incident involved a resident going missing from the home and who was not returned to the home until the following day. The registered person had again failed to notify all the relevant authorities. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 18 During examination of the home’s records it was identified that this individual had left the home a few days before the above incident and had been found by the staff and brought back to the home. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The physical environment continued to deteriorate whilst refurbishment plans were being finalised. EVIDENCE: The physical environment continued to deteriorate. The manager was planning to convert many of the bedrooms into en-suite facilities. Plans had been sent to the architects. The manager was waiting for quotes for the electrical and plumbing works so that a separate boiler for each side of the building would service the home. This would be an improvement as there had been problems with hot water servicing the whole of the home. There were adaptations in the home to assist residents with physical disabilities to be able to access all areas of the home including a ramp into the home and garden, and, a shaft lift to access part of the second floor. There were assisted bathing facilities and a emergency call system was in place. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 20 During this inspection only some areas of the home were examined. Bedrooms on the ground floor of the old side of the building were in need of decoration, furniture was old and some handles were missing off the drawers and wardrobes, privacy and dignity was not being promoted by the use of appropriate privacy curtains and window dressings. It was difficult to determine whether the rooms were singly or doubly occupied. One of the wardrobes had clothing identifying three different residents. The bathroom between these two bedrooms needed to be re-decorated. The over bath shower had been disabled since the last inspection as the temperature of the hot water could not be limited to 43 degrees. The pressure of the hot water to the bath was very low and the water would have been cold by the time the bath had enough water in it for bathing. One of the chairs in the main lounge was badly ripped and needed to be removed. There was fluorescent lighting in the lounge. The dining room appeared to meet the needs of the residents. A small oil filled heater was available in the conservatory. The small garden area was not very inviting. There were some items eg slabs, broken plastic chairs that needed to be removed. Issues of infection control that were identified in the bathroom/shower room on the ground floor were that the rusty chair identified at previous inspections was still in the shower. This chair needed to be removed and the other chair and bath chair needed to be cleaned. There was no liquid soap in the bathroom for washing hands and the bottom of the shower curtain needed to be cleaned. The light pull-cord in the toilet opposite the small lounge was very dirty and toilet seats were missing. There was soiled clothing in the manual sluice on the first floor leaving an odour in the area. Odour control was also an issue on the first floor by the bedrooms across the corridor from the manager’s office. There was an issue with hot water temperatures in the home. The hot water temperature from the shower on the ground floor was not restricted, the hot water temperature of the bath and wash hand basin were also too hot to keep the hand continually under it. The registered person stated that the home was not checking the water temperatures but could not say why they were not being checked. In the ground floor bathroom the piping was exposed behind the toilet pan. The registered person stated that there had been a leak some time ago but was not aware that the pipes were exposed. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 21 The flooring in some bedrooms required replacing or cleaning. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels can meet residents’ basic needs. Training has improved but some mandatory training remains outstanding. EVIDENCE: Two staff recruitment files were sampled. Both members of staff had been recruited from overseas by an agency. All the appropriate documentation was in place. The registered person indicated that he tried to maintain 3 care staff on duty during the day. During the week there was also a manager, deputy and cook on duty. At weekends 3 care staff were on duty one of whom did the cooking. This individual was identified on the rota. The staffing levels allow basic needs to be met however, additional staff are required in order to meet residents social needs. Since the last inspection the cleaner had retired, and two care staff had been dismissed. Some staff were working 60-70 hours which the registered person was not happy about, but it was the only way to cover the shifts. Information about an incident following which two staff were dismissed was only given after the inspector identified that she was already aware of the Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 23 incident. Documentation about the investigation was not found during the inspection. Staff had undertaken adult protection training, fire training, dementia, introduction to administration of medications and infection control training since the last inspection. The registered person needed to know what issues had been covered in the training in order to monitor the staffs’ increase in knowledge and improvements in practice. Other training identified at the previous inspection remained outstanding. The registered person must ensure that staff-undertaking manual handling assessments are competent to do so. There was no evidence that the new staff had undertaken any induction training that linked to the Skills for Care competencies. The staff had undertaken some training but it appeared that it was all on one day and it could not be determined which areas had been covered. The registered person needed to develop a training matrix for staff so that the future training needs of the staff could be planned and arranged. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32,33,35,36,37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home needed to be improved to ensure that residents were safeguarded, the physical environment improved and there was better management of records in the home. EVIDENCE: The registered persons health was failing and he told the inspectors that he intended to step back from the day-to-day management of the home and appoint a manager and deputy manager. An individual had been identified as the prospective manager. The registered person spoke with the inspectors about the plan to refurbish the home to enable the home to offer en-suite accommodation. Plans were with the architect and he was waiting for quotes for plumbing and electrical works. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 25 The home has continued to deteriorate and although there is acknowledgement that plans are being developed the CSCI cannot allow the conditions to fall below acceptable standards. The registered person must liaise with the CSCI regarding timescales for the above plans to be brought to fruition. The registered person had delegated tasks down to staff who had been developing the care plans. There had been some improvement but there was a need for further improvement of risk assessments and strategies for the management of challenging behaviours. The response to some incidents within the home had indicated that the registered person had not remained updated on the procedures in the home and the actions required of a registered manager. There were some incidents that had occurred in the home which the CSCI was required to be informed of including staff disciplinaries, residents going missing from the home and any behaviours of residents that affected them or others. There was no evidence of any staff meetings or residents meetings being held. The registered person told the inspectors that he had delegated quality assurance tasks to some of the staff but that these had not yet been carried out. Some residents managed their own finances, some were managed by families and some were managed by the local authority. The registered person was not always made aware of who the relevant individual in the local authority was. Monies for some of the residents continued to be paid into Sycamore House’s accounts. Although this was not a satisfactory situation the home was finding it difficult to open individual accounts for the residents. No interest payments were being made on the amounts being held for individual residents. There were records being maintained for purchases being made on behalf of residents. It was recommended that items purchased were recorded rather than recording ‘goods bought’. There was one resident who had purchased a pillow and there was no reason for this. The registered person needed to reimburse the individual. There was no evidence on the files sampled that the staff had been supervised. There were some issues of health and safety that were identified during the inspection including hot water temperatures that had been identified at previous inspections. There was a stepladder stored in one bedroom, which could pose a risk to residents. There were some broken plastic chairs and slabs that needed to be removed from the garden area. Infection control needed to be improved in some areas of the home. Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 26 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 1 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 2 2 X 2 1 1 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 1 1 2 Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(1) Requirement Timescale for action 01/06/07 2. OP3 14(1) 3. OP7 15(1) The registered person must ensure that the residents are made aware of the conditions of residence and that the contracts are appropriately completed at the time of entry to the home. The registered person must 01/06/07 ensure that a full and holistic assessment is carried out of residents needs before admission to the home to ensure that the home is able to meet their needs. The registered person must 01/08/07 ensure that residents’ plans are comprehensive and provide sufficient detail to enable care staff to meet the assessed needs of residents. (Partly complied with.) Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 28 4. OP7 13(5) The registered person must 01/07/07 ensure that there is a moving and handling assessment in place for all residents indicating the actions to be taken in the event of a fall and any equipment to be used. (Previous timescales of 01/08/06 and 01/12/06 not met.) Manual handling assessments must be carried out by an experienced and competent individual. Strategies must be in place to manage any challenging behaviours displayed by the residents. Residents must be involved in drawing up their care plan and in any reviews. (Previous timescales of 01/10/05, 01/02/06, 01/08/06 and 01/12/06 not met.) Records must enable easy tracking of medical visits to residents and the reasons for the visits. (partly met.) The medication policy must be adapted to apply specifically to the home. (Not assessed for compliance at this inspection.) The registered person must ensure that residents are given their medicines as prescribed. Medicines must be booked in on receipt and any carry over of medicines from one month to the next must be recorded on the MAR chart. 5. OP7 13(4)(c) 01/06/07 6. OP7 15(1) 01/08/07 7. OP8 12(1)(a) 01/08/07 8. OP9 13(2) 01/06/07 Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 29 9. OP10 12(1)(a) The registered person must ensure that residents are facilitated to lock their bedrooms where they want to. Residents must be provided with privacy curtains and suitable window dressings to promote their privacy and dignity. The registered person must ensure that residents are consulted regarding activities and social interests and make arrangements to enable them to engage in activities in the home and the local community. (Previous timescales of 01/04/05, 01/10/05, 01/03/06, 01/10/06 and 01/01/07 not met.) Staff must include in daily records any activities undertaken to show that the residents social needs are being met. (Previous timescales of 01/09/05, 01/02/06, 01/08/06 and 01/01/07 not met.) The registered person must ensure that he and all staff are fully aware of the procedures to follow in the case of an allegation or suspicion of abuse. The registered person must ensure that any areas including lounges, bathrooms, bedrooms and corridors, requiring redecoration are dealt with during the refurbishment programme and water damaged ceiling tiles must be replaced. (Previous timescales of 01/08/04, 01/11/05, 01/04/06, 01/10/06and 01/04/07 not met.) Torn chairs in the lounges must be taken out of use. (Previous timescales of 14/01/06, 14/08/06 and 01/03/07 not met.) DS0000016849.V334799.R01.S.doc 30/05/07 10. OP12 16(2)(m) & (n) 01/08/07 11. OP12 12(1)(a) 01/07/07 12. OP18 13(6) 30/05/07 13. OP19 23(2)(d) 01/08/07 14. OP20 16(2)(c) 01/08/07 Sycamore House Version 5.2 Page 30 15. OP21 23(2)(b) The registered person must ensure that the missing tiling in the toilet on the ground floor is replaced. (Previous timescales of 01/02/05, 01/09/05, 01/04/06, 01/08/06 and 01/12/06 not met.) 01/08/07 16. OP24 16(2)(c) 17. OP25 23(2)(j) The handle on the door to the bathroom on the ground floor must be fitted on. The registered person must 01/08/07 ensure that all bedroom furniture is repaired. (Previous timescales of 14/06/04, 01/10/05, 01/04/06, 01/09/06 and01/04/07 not met) Secondary lighting that is in 01/08/07 working order must be available to all residents in their bedrooms. (Previous timescale given 01/08/06 and 01/01/07. Not assessed for compliance at this inspection.) Fluorescent lighting must be replaced with domestic type lighting. (Previous timescale of 01/01/07not met.) Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 31 18. OP26 13(3) Dirty carpets must be cleaned or replaced in the bedrooms. (Previous timescale of 01/09/06 and 01/01/07 not met.) Arrangements must be made to provide a wash hand basin in the laundry. (Previous timescale of 01/09/06 and 01/01/07 not met.) The rusty shower chair must be removed and the other chair scrubbed clean. Dirty light pull cords must be replaced. (Previous timescale of 01/01/07 not met.) The registered person must ensure that records are kept and are accessible for all investigations undertaken into the conduct of staff at the home. All staff must undertake mandatory training in first aid, food hygiene and health and safety. (Previous timescales of 01/04/06, 01/09/06 and 01/12/06 not met.) All staff must be given induction training in the home. (Previous timescale of 01/09/06 and 01/12/06 not met.) Staff must be provided with training in epilepsy and mental health awareness. (Previous timescale of 01/09/06 and 01/12/06 not met.) A training matrix and staff development programme must be put in place. (Previous timescale of 01/12/06 not met.) 01/08/07 19. OP27 17(2) Sch 4(6)(f) 18(1)(c) (i) 30/05/07 20. OP30 01/09/07 Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 32 21. OP31 12(1)(a) 22. OP33 24(1) 23. OP35 17(2) Sch 4(9)(a) The registered person must ensure that tasks are appropriately delegated and that checks are in place to ensure that they are undertaken. (Previous timescale of 01/01/07 not met.) The registered person must ensure that there is a system in place in the home for reviewing and improving the quality of care provided. (Previous timescales of 01/12/05, 01/04/06, 01/10/06 and 01/04/07 not met.) The registered person must ensure that the money identified during the inspection is reimbursed to the resident. Items purchased must be identified on the records so that it is clear what has been purchased on behalf of the residents. The registered person must ensure that all staff are supervised, with written records, for a minimum of 6 sessions in any 12-month period. (Previous timescales 01/04/04, 01/04/06, 01/10/06 and 01/12/06 not met.) The registered person must ensure that notifications are forwarded to the CSCI in compliance with the care homes regulations. The registered person must ensure that the stepladders are removed from the bedroom and stored appropriately. The registered person must ensure that the broken plastic chairs and slabs are removed from the garden. 01/06/07 01/08/07 30/05/07 24. OP36 18(2) 01/08/07 25. OP37 37 14/05/07 26. OP38 13(4)(c) 20/05/07 Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sycamore House DS0000016849.V334799.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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