Inspection on 22/07/08 for Sycamore House

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Adequate service.

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

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Snydale Care Home

Hawkhills

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/10/2008.

CARE HOMES FOR OLDER PEOPLE Sycamore House Wawne Road Bransholme Hull East Yorkshire HU7 5YS Lead Inspector Beverly Hill Unannounced Inspection 22nd July 2008 09:30 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 DS0000070917.V368825.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 DS0000070917.V368825.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore House Address Wawne Road Bransholme Hull East Yorkshire HU7 5YS 01482 878398 01482878698 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) Sycamore Care Ltd Miss Teresa Montana Care Home 36 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (36) of places Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE The maximum number of service users who can be accommodated is: 36 New Service 2. Date of last inspection Brief Description of the Service: Sycamore House is located in the Sutton area of Hull close to local facilities and bus routes. It provides personal care for up to thirty-six people including those who may have dementia care needs. The home has recently been purchased by Sycamore Care Ltd, however the registered manager has remained the same. The home is purpose built with all facilities and services at ground floor level accessible to wheelchair users. There are three lounges, one of which is quite small and used for people that wish to smoke, and a large dining room. There is also a kitchenette for relatives to make refreshments and a separate room for the hairdresser. Thirty-four of the bedrooms are single rooms, none of which have en-suite facilities. There is one shared bedroom. The home has five bathrooms, one of which has an assisted bath. In addition there is a walk-in shower room. There are sufficient toilets throughout the home and close to communal areas. The home benefits from car parking space to the front and an enclosed lawn and paved area to the rear leading from the dining room. The garden has recently been landscaped and provides a very pleasant area for residents. The home is clean, tidy and welcoming. According to information received from the home the weekly fees are between £305.50p and £371. There is a third party top up system of £17 each week but this can be negotiable. Additional charges are made for hairdressing, chiropody, transport, newspapers, nametapes, holidays and outings, and Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 5 alcohol and cigarettes. Information about the home and services can be located in the statement of purpose and service user guide, available from the manager. Each resident also has a copy of the service user guide in his or her bedroom. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 6th July 2007, the random inspection on 17th December 2007 and including information gathered during a site visit to the home. This site visit started at 9am and finished at 9pm. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Sycamore House. We also had discussions with the company’s area manager, the homes registered manager, the deputy manager and two care staff members. Information was also obtained from surveys received from eight people that live at the home, one relative and six staff members. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We checked how staff monitored the food and fluid intake of those with nutritional risks. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Sycamore House, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? A new company has purchased the home and made some changes to the management support systems. The environment has improved with the redecoration of three lounges and the landscaping of the garden. The latter provides a very pleasant place for people to sit and enjoy the warmer weather. Several bedrooms have also been redecorated and re-carpeted. New chairs have been purchased for two of the lounges. The home provided some activities for people to participate in but people with dementia care needs really required more stimulation. The homes writes to prospective residents letting them know, after the assessment, whether they can meet their needs. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 8 Staff members have the opportunity to complete training in dementia awareness. The manager has completed a, ‘train the trainer’ course in how to safeguard vulnerable adults from abuse and made sure that all staff are now fully aware of procedures. The deputy manager oversees new staff as they progress through their induction. New documentation has been introduced regarding assessment and care planning. Also there is a new system of recording the care people receive at night. What they could do better: The homes statement of purpose and service user guide weren’t quite completed. These were important documents, as they gave the initial information to people about the home and the services it provided. The way the home writes care plans has improved but they still miss things out and this could mean that care will be missed. Also one specific person needed to have a detailed plan to guide staff in how they were to support them in particular areas. This wasn’t always clear and meant that staff couldn’t give consistent care. Staff didn’t always fill in monitoring charts so it was hard to evidence if care was provided as it should be. There were some times when staff didn’t follow care plans. This was really important to make sure peoples needs were met. The way the home managed medication must improve so that it is stored and recorded properly. Some activities were provided for people but these could be improved for people with dementia care needs. The staff could make sure that all residents are aware that they have choices about the times they get up and go to bed. The home has routinely employed people before the return of the criminal record bureau check, although always after a check of the protection of vulnerable adults register. This system should only be used in exceptional circumstances and not routinely. Having good recruitment practices and safe moving and handling techniques will help to protect people from harm. The home has a training plan and this includes dementia awareness but it could include other conditions affecting older people, for example strokes, diabetes, Parkinson’s disease, sensory impairment and arthritis etc. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 9 The way the home monitors the quality of the service it provides and its record keeping could be improved to ensure everything is up to date. Two staff were seen moving and handling a person to reposition them in their chair in an unsafe way. It is important that staff only use approved ways of moving and handling people to prevent injuries. 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 DS0000070917.V368825.R01.S.doc Version 5.2 Page 10 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 DS0000070917.V368825.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide is missing information in some of the sections. This means that people may not have full information to assist them when choosing residential care. People are only admitted to the home after a full assessment of their needs and the home obtains copies of assessments completed by the local authority for people funded by them. This enables the home to decide whether they are able to meet peoples’ needs. EVIDENCE: The manager was in the process of completing the home statement of purpose, which, currently was in a template form and needed specific information related to Sycamore House. The statement of purpose required the following information in order to meet the standard and ensure people had the correct Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 12 and up to date information about the home so they can make informed decisions: • Relevant qualifications and experience of the registered provider and registered manager. • The number, relevant qualifications and experience of staff working at the home. • The age-range and sex of the service users for whom it is intended that accommodation should be provided. • The range of needs that the care home is intended to meet. • Whether nursing is to be provided. • Full details of the complaints process. • The number and size of rooms in the home. The service user guide has been completed and each person has a copy in his or her bedroom. The manager confirmed this was also available in large print form. The home has also produced a brochure with added points of interest. The service user guide needs to have the relevant qualifications and experience of the registered provider, manager and staff. Because both the service user guide and the statement of purpose have this information missing people cannot be sure that the home will be able to meet their needs. Each person is provided with a statement of terms and conditions when they are admitted to the home. We examined three care files during the visit, two of which were for people recently admitted to the home, to check the assessment process. The two new admissions contained assessments of need and care plans, produced by the local authority for people funded by them. The third file was for a person admitted to the home eight years ago. The management team had completed the homes own assessment on all three people to check there had been no change in need. The homes own assessments contained quite comprehensive information and covered all aspects of health, social, emotional and psychological needs. This enabled them to make a decision about whether they could meet needs. Personal profiles were not completed fully but the assessment did cover preferences and diverse needs. The manager confirmed they or the deputy manager visited people to complete the assessments. This could be in the persons’ own home, whilst they were in hospital or at another residential home. The manager formally wrote to people stating that, having regard to the assessment, the home was able to meet the identified needs. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 13 The manager confirmed people were able to visit the home for trial visits, to have lunch and meet people already living there. The home could also accommodate people for respite services. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally people were provided with support in ways that promoted their privacy, dignity and independence. However some gaps in care planning, risk assessing and recording means that staff may not have full information about specific tasks and specific care has been missed. The recording and storage of medication was not sufficiently robust to evidence good management and ensuring all people received the medication as prescribed for them by their physician. EVIDENCE: The care files had information from assessments, risk assessments and local authority care plans to enable staff to produce plans of care to meet the identified needs. We examined three care files during the visit, which were divided into sections. The manager is in the process of changing to new Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 15 documentation, which could account for the deficits found in the care plans examined. Some sections of the care plans were individualised and detailed, for example one plan highlighted the need for continence management and indicated the type of incontinence aids and where these could be located in the persons bedroom. It was clear about how often to check the person, 2 hourly and what to use to prevent breakdown of skin. However the person also had other needs that were not planned for sufficiently. These included insulin dependant diabetes, a pressure ulcer on her hip, social stimulation and nutritional changes. The care plan for nutritional needs did indicate a sugar-free diet and liaison with the district nurse about blood sugar monitoring but as the person had some history of unstable diabetes and treatment from emergency care practitioners for hypoglycaemic states there must be a comprehensive plan to give guidance to staff. It did not indicate the need for food supplements, although the daily notes indicated these were provided. There was some indication that staff members were not following the care plans. For example the same person used a wheelchair to sit in during the day and their care plan for mobility needs stated they required a lap strap for safety – this was not in place. The person was not checked at 2 hourly intervals for continence management. The food and fluid monitoring chart had an entry for 7.30am as incontinent of urine but no further input. We observed the person from just prior to 10am until after lunch and no monitoring checks were made. The person pressure areas were not relieved during that time and a monitoring chart not completed for this. The person’s fingernails were in need of cleaning and although staff members spoke with her throughout the morning we had to raise this with them as an issue. The person was also not moved and handled as their care plan and safe practice dictates. Staff members were observed using a draglift, no longer considered safe to use, to reposition the person. A second care plan examined detailed the person had needs associated with their memory impairment and covered areas such as maintaining a safe environment, personal hygiene, continence management and unsettled sleep patterns. There was no care plan to cover her nutritional needs, social stimulation or communication. The manager stated that as the person had a ‘normal diet’ this was not required but the person experienced memory impairment and needed reminders and prompts to ensure they completed their meals. The care plan for continence management stated their fluid intake needed to be monitored but there was no chart for this. The third care file examined indicated the person had some behaviour’s that were challenging to self, other residents and care staff. The person needs to have a full behaviour management plan detailing the types of behaviour and guidance for staff in what actions and approaches they have to use to support Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 16 them. There was evidence the home had sought advice from health professionals and a best interest meeting was to be held. Care plans were being evaluated but some of the information highlighted, for examples changes in need or observations made by staff was not being inputted into plans to update and make staff aware of the changes. There was evidence of care plan reviews but review documentation was not in the file for one of the people recently admitted. It would be expected that the person had a review after the first few weeks to decide if the admission was to be permanent. There was evidence of some risk assessments being completed, for example for general moving and handling needs, falls, pressure ulcers, nutrition and individual risks such as bed rails, smoking, leaving the building and agitation. There was some discrepancy between a nutritional risk assessment for one person that suggested they be weighed weekly, (at least initially) the care plan that stated weigh weekly and the action taken by staff which was monthly weight monitoring. Part of the risk assessment for bedrails for one person was missing. This was the part that checks whether the person actually requires the bed rails and whether any confusion should preclude them from being in place. There was a consent form signed by relatives in February 2007 regarding a lap strap for one person in a wheelchair but no thorough risk assessment for this. This needs re-visiting to check it is still required. There was evidence of referral to health professionals for advice and treatment, and recorded visits from district nurses, doctors, emergency care practitioners, opticians and chiropodists. One person had recently been referred to a dietician and the intensive outreach team had been involved for another. People had their weight monitored but it could be clearer when this is required more frequently than monthly. Recording of care during the night had improved and staff signed daily to state they had completed all their paperwork. Daily recording had improved although there were still areas for improvement including, for example, monitoring charts for pressure relief. As mentioned some care plan tasks were not recorded as carried out. One persons’ care plan states they are to be offered nail care and a shower or bath weekly. As the person has double continence issues this was important. However the daily notes available for just over the last two-week period indicated the person had not been offered a bath or shower and had received only a daily body wash. Key worker notes also suggested a month ago that the person was unable to hear via their hearing aid. There did not appear to be any follow up and we observed it not working on the day of the visit. A relative also expressed concern in a survey that staff did not pay sufficient attention to hygiene, pressure areas and whether hearing aids were working properly. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 17 In discussion staff told us they read the care plans and had information about peoples’ needs. They also had a good understanding of how to maintain privacy and dignity when supporting with personal care. In practice this could be improved in some areas to ensure staff are observant of peoples’ hygiene needs, for example nail care, shaving for one person and foot care for another (they were observed with their bare swollen feet resting on wheelchair footplates with no clean covering over the plates). The manager advised that staff were usually vigilant regarding nail care as there had been an incident since the last inspection of a residents’ nails digging into his hand and causing a severe sore, which had to be treated by health professionals. People spoken with described care provided to them that respected their privacy and dignity, ‘the staff keep me covered up’. One person who was smartly dressed said, ‘the staff are very good to us’. All eight people who completed surveys wrote that they received the care and support they needed, ‘always or usually’ and that staff listed to them, ‘always’. One relative wrote that staff could take extra care to ensure people received their own belongings such as clothes after laundering. Medication was maintained securely and each resident had a photograph and information about their GP and any allergies. There were some areas in the management of medication that required attention. • Shelf-limited medication such as eye drops needs to have the date of opening on the actual item. • One persons’ medication had been changed by their GP in mid cycle and staff had handwritten the changes but did not include the full manufacturers instructions. • There had been instances when the temperature of the medication room was recorded as 27°C. Medication must not be stored above 25°C. • Prescribed creams were not always recorded as applied. • In some instances Lactulose medication was prescribed, ‘as directed’. This does not give clear instructions to staff. • One person was recorded as not taking their prescribed Calcium Carbonate medication for several doses but their GP had not been informed. • It was recorded that one person had not received prescribed Lactulose medication for seven days, as it was not in stock. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The activities provided did not appear to meet everyone’s needs especially in relation to people with dementia. The home had flexible routines and promoted choice and individual decisionmaking but some residents appeared unsure of their right to exercise choice in specific areas. The home provided meals that met peoples’ nutritional needs. EVIDENCE: The home provided a range of in-house activities such as bingo, quizzes and games, painting, dominoes, exercise to music, sing-a-longs, birthday and other seasonal parties, watching films and craftwork. The occasional outing was arranged and some people went to local shops. The home had a dedicated activity coordinator and budget. In surveys staff stated they helped to raise funds for activities and outings. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 19 Stimulation for people with dementia care needs was limited and the group of people falling into this category need to have their personal profiles examined and activities tailored to meet their abilities to participate in them. This was a requirement issued at the random inspection in December 2007 and remains unmet. The activity record for one of the care files examined only detailed bingo (three times), reminiscence (once) and a party (once) in the last three months. A second file recorded bingo once and attendance at a party as the only activities in the last five months. There were two, ‘declines’ recorded in June and July. The third file had declines since admission five months previously yet the person was very chatty with us when we discussed their life prior to admission. The declining to participate could be a reflection of choice or the activity is not to their liking/needs/abilities. In surveys three people stated they had enough activities, ‘always’, whilst five people said this was ‘usually’. A relative said that activities had decreased in frequency lately. Some people obviously joined in more than others and choice was respected. Staff in surveys thought they offered a good choice of activities and in discussions stated, ‘the activity coordinator does a lot with people’. Some connections with the local community have been maintained, for example, local school children visit the home on seasonal occasions and last year sang carols to the residents. One resident continues to attend a day centre. The home does not hold church services any longer although the service user guide suggests it does. This needs checking out and rectifying. People spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussions with staff. A relative commented in a survey that staff could be more proactive about informing them of issues, ‘info is given on request but rarely volunteered’. People were able to make some choices about aspects of their lives. Some people chose to continue smoking and facilities were arranged for this, some people managed their own personal allowance and some had keys to their bedroom doors to offer them privacy. Staff stated people had the choice of where to sit and have their meals, the times of rising and retiring and whether they preferred to stay in their bedrooms. One resident spoken with was unsure whether they had a choice about the time they get up, ‘I have to get up at 8 o’clock’. They stated they would prefer to get dressed after breakfast but also said, ‘staff like me up and dressed before’. This needs to be checked out to ensure people are fully aware of their choices and that these are respected. People spoken with generally enjoyed the meals provided by the home. Out of eight surveys received three people stated they liked the meals ‘always’ and five said this was ‘usually’. Comments were, ‘the food is so-so’, ‘its very good’, ‘you can have what you want – you get plenty to eat’ and ‘there are usually Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 20 alternatives’. One person told us that staff provided jugs of squash in each of the bedrooms during the day. The menus rotated over a four-week period and offered an alternative to the main meal provided. Special diets were catered for and food supplements obtained via residents own GP’s. Staff members were observed supporting people to eat their meals in a patient and sensitive way. The home had gained an ‘A’ in Hull City Council’s ‘scores on the doors’ assessment system of food management. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continues to provide an environment where people and their relatives feel able to complain. Although safeguarding procedures have improved since the last inspection, a gap in recruiting staff and unsafe moving and handling techniques means that people have not been protected as robustly as required. EVIDENCE: The homes complaints policy and procedure was on display and via surveys staff indicated they were aware of how to record and action complaints. The procedure detailed information regarding where people could take their complaints if they were not satiisfied fiollowing the first stage. A complaint form was available that had space to detail the complaint, how it was investigated, what the outcome was and what, if any, action was taken. The homes AQAA states they have received one complaint in the last twelve months, however there were four complaints indicated in the complaints file and all had been dealt with. The Commission had also received a complaint, which was passed to the provider to investigate. This was completed to the satisfaction of the complainant. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 22 People spoken with stated they were aware of how to complain and who to speak with if they had any concerns, ‘I would tell Theresa (manager) – I had to complain once and it was sorted’ and ‘I’ve never had one – I would tell her in charge’. In surveys most people wrote that they knew how to complain and who to speak to if they were unhappy. Since the last inspection there have been five safeguarding of adults allegations. One is still being investigated by the police. The others mainly related to health care issues and have been resolved with no further action required. The ongoing investigation was initially not managed well by the registered manager and previous provider. It was not seen as a safeguarding of adults allegation and there was a delay in referral to the local authority for investigation. The registered manager has since completed further safeguarding training and is now fully aware of her responsibilities in alerting, referral and investigation procedures. The registered manager has also completed a, ‘train the trainer’ course so is able to cascade the training to other stafff members within the home. Staf members spoken with were clear about the procedure used should they witness any abuse. All staff other than very new employees had completed safeguarding training. There were some gaps in the homes recruitment processes, which means that staff members start employment before the return of the criminal record bureau check but after the povafirst (protection of vulnerable adults register) check. This must only be done in exceptional circumstances and not routinely. Also two staff members were observed moving and handling someone using a technique no longer considered safe. One person had completed moving and handling training but the person assisting them had not. This technique could potentially be harmful to people and updated training must be arranged. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 23 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, 22, 24 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The providers had improved the environment since the last inspection and provided a clean, safe and homely place for people to live in and staff to work in. EVIDENCE: The home is purpose built with all facilities and services at ground floor level and accessible to people in wheelchairs. Communal areas consist of three lounges, the smaller of which has now been made into the room for people wishing to smoke, a dining room, hairdressers’ room and a garden. There is a kitchenette for relatives to make refreshments. One of the corridors had a seating area that some people liked to use to watch the comings and goings in the home and there is also a small seating area in the entrance. The home has five bathrooms and one shower room and sufficient toilets appropriately placed throughout. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 24 There have been improvements in the environment since the new owners purchased the home. All three lounges have been redecorated and the two larger ones have been re-carpeted and provided with new chairs. The dining room is quite large and has been provided with new tables and chairs. Several bedrooms have been redecorated and new carpets provided in some of them. A rolling programme is underway regarding the remaining bedrooms. The shower room has had a new floor and equipment, and the enclosed garden has been landscaped providing a lawned area, patio, raised flower containers making it easier for residents to participate in their upkeep and a pergola. This gives a very pleasant space for people to sit outdoors and enjoy the warm weather. The home had thirty-four single bedrooms and one shared bedroom, none of which have en-suite facilities. People spoken with were happy with the home in general and with their bedrooms, ‘I have a key for my door, I don’t want people wandering in and out’, ‘I’m quite happy with my room’ and ‘the home is clean and kept tidy’. They confirmed they were able to bring in items of furniture to personalise their rooms, which was seen to varying degrees, ‘I have my own bed and things around me’. The staff stated they had sufficient moving and handling equipment available in the home to support people. Corridors were wide enough for wheelchairs and had grab rails. Bathrooms and toilets had appropriate rails and the home had a nurse call system throughout. The home had sufficient laundry equipment and had a pleasant odour on the day of the visit. Seven of the surveys received from people living in the home stated the home was fresh and clean, ‘always’. One person stated this was, ‘usually’. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some gaps in training and practice mean that staff members may not have the required skills to meet peoples’ diverse needs. The homes recruitment processes were not sufficiently robust to safeguard vulnerable people. EVIDENCE: Discussions with care staff members and information from the manager indicate that there are three care staff members, and the registered manager on duty during the day, and two care staff at night. The manager calculated the home provided 434 care hours a week. The home has ten vacancies at present and staff members do not feel rushed when providing care. Should the vacancies be filled, staffing levels would have to be adjusted. The home has a weekly operating report which looks at occupancy and from this calculates the number of care hours required. Comments about the staff were, ‘they look after me as well as can be expected’, ‘they are very good to us’, ‘they’re are alright’, ‘they are not bad but we look after ourselves’ and ‘we have no problems at all there’. A relative said, ‘staff are always pleasant and cheerful and make her feel part of the Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 26 family’. Surveys received from people stated staff were available and that they listened to people. The manager had completed a training plan for the coming year, which covered mandatory training, and some service specific courses such as mental capacity legislation, bereavement awareness, equality and diversity, care planning, and dementia care. A training matrix was available in the managers’ office to record when staff had completed the training and when updates were due. There were some gaps observed but generally staff had opportunities to improve their skills and knowledge. The home could provide training in conditions affecting older people within the home, for example how to manage the care of those experiencing strokes, diabetes, Parkinson’s disease, arthritis and sensory deficits. During the day two staff members were observed using a draglift to reposition a person in their chair. This is an unsafe moving and handling technique and must not be used. The manager confirmed one of the staff members was new in post and had not received any moving and handling training yet and the other person needed practical moving and handling refresher training. This was currently being sourced and should be a priority. The deputy manager completed induction for new staff members and confirmed the booklets used conformed to skills for care guidelines. New staff members worked through a set of common induction standards to test their competence and the deputy manager signed them off when satisfied. According to information received on the day the home had ten care staff that had completed a national vocational qualification (NVQ) at levels 2 and 3. This equated to 50 and was a good achievement. There were further staff progressing through the training and once completed the home will have exceeded this standard. Generally the home made sure that people had checks prior to starting work. References and criminal record bureau checks were obtained and checks made against the protection of vulnerable adults register. Care staff members were selected via an interview process. All four new staff files examined evidenced that they had started shifts after the povafirst check but prior to the return of the criminal record bureau check. This must only occur in exceptional circumstances and must not be routine practice. The staff files did not have photographs of them. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally the home is managed well and there has been improved support systems put in place with the change of ownership. However some shortfalls in health and safety need to be addressed to ensure the health and welfare of people that live in the home. EVIDENCE: The manager has been in post for approximately two and a half years and is progressing with the Registered Managers Award. She has completed a ‘train the trainers’ course in safeguarding adults from abuse and a twelve-week health and safety course with the local authority. She had also completed oneSycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 28 day courses in dementia care, challenging behaviour and equality and diversity. She has up to date certificates in fire safety and basic food hygiene. Staff spoken with described her as approachable and supportive, ‘we feel we can go to her with anything and she will get things done’. In surveys staff stated that they had the opportunity to meet with the manager either ‘always’ or ‘usually’. The new company employs an area manager and there was documentation to evidence their monthly visits to the home in line with regulation 26 of the Care Homes Regulations. Staff spoken with stated that there had been improvements in the home and support systems since the change of ownership. Morale had improved and the home in general looked better. Staff had the opportunity to talk with the area manager during their visits. Staff meetings were also held to exchange information and for people to express their views. The home had a new quality monitoring system that consisted of audits and questionnaires to people that live in the home and relatives. All residents and their families were sent an initial questionnaire in April 2008 and approximately 33 were returned. There needs to be analysis of the results and action plans to address any identified shortfalls. The manager confirmed the new system allowed for questionnaires to be sent monthly to 33 of residents so that after a three-month period all residents would have been consulted about particular issues. Questionnaires had not been sent to staff and visiting professional yet to obtain a wider view regarding the management of the home. Residents also had the opportunity to make suggestions during meetings, which were held every three months and the manager described how they had one to one chats with people daily. The home also maintained a comments file regarding meals. This could be checked more often to ensure suggestions are followed through. Generally families managed finances although the home held a small amount of personal allowance for twenty-four people. This was usually for hairdressing, chiropody and small purchases. Individual records were maintained and two signatures for transactions. Receipts were obtained for money deposited into the personal allowance system and when staff members assisted people to purchase items from local shops and on outings. Some residents were still able to manage their money and lockable facilities were available in bedrooms to store personal possessions or finances. Staff supervision consisted of one to one discussions covering a range of topics such as, customer care, care practices, procedures, staff relationships, personal presentations, hours worked, training and awareness of abuse. Staff members were on track to receive six supervision sessions per year. They also Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 29 had annual appraisals when training needs were discussed. The manager stated they had an open door policy for staff to speak to her whenever they had an issue. This was confirmed in discussions with staff. There was evidence that not all the documentation required for the running of the home was in place and up to date. Shortfalls in documentation covered the statement of purpose and service user guide, care plans, some risk assessments, a behaviour management plan for one person, incomplete monitoring charts and photographs of new staff. Generally the home was a safe place for people to live in, and staff to work in. Some health and safety issues were noted such as, a residents care plan indicated the need for a lap strap when they used a wheelchair but this was not in place, two staff were observed using an unsafe moving and handling technique and some bedroom doors were wedged open. Staff had training in health and safety practices arranged for this month. It became apparent that staff had not received practical moving and handling but had received training via watching a video and answering relevant questions. It is important that staff receive practical training and the manager confirmed this had been arranged. Staff members were able top access policies and procedures for reference and guidance. The AQAA stated that equipment in the home was serviced regularly and fire alarm and equipment checks were carried out. The manager audited accidents monthly to check for patterns. This included the time, location and injury sustained. There was evidence that staff contacted emergency care practitioners to check any injuries sustained by people when they fall. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 2 2 Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 31 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 OP1 Regulation 4 and 5 Requirement The registered person must ensure the homes statement of purpose and service user guide contains full and up to date information. This will enable people to have accurate information to hand when they decide whether the home is able to meet their needs. The registered person must ensure all changes in need highlighted in care plan evaluations must be transferred to the actual care plan so care tasks will not be missed. (Previous timescale of 31/01/08 not met) The registered person must ensure all needs identified at the assessment stage have plans of care in place to meet them. This will give clear guidance to staff and ensure care is not missed. The registered person must ensure that a specific resident has a management plan that will give guidance to staff on how to manage aspects of their behaviour that could be DS0000070917.V368825.R01.S.doc Timescale for action 30/11/08 2 OP7 15 31/10/08 3 OP7 15 31/10/08 4 OP7 15 30/09/08 Sycamore House Version 5.2 Page 32 5 OP8 12 6 OP8 13(4) 7 OP9 13 challenging and could compromise their hygiene. The management plan to include what works well for the person, what approaches to use and when to seek professional guidance and advice. This will ensure staff have clear guidance to assist them when supporting the person. The registered person must ensure that tasks for staff identified in care plans are carried out consistently. This will ensure peoples’ needs are met. The registered person must ensure risk assessments are accurate and complete to give full information and guidance to staff. The registered person must ensure: Shelf-limited medication has the date of opening on the actual item. Prescribed creams are recorded when applied. Clear instructions for staff regarding the dosage of all medication including lactulose. Better stock control for one persons’ medication. Ensure a system is in place to inform the GP when people do not to take prescribed medication. The registered person must provide a range of activities and occupations suitable for all service users needs. Service users need to be consulted on the range of activities on offer and alternatives provided if DS0000070917.V368825.R01.S.doc 31/08/08 31/08/08 31/08/08 8 OP12 12 and 16 31/10/08 Sycamore House Version 5.2 Page 33 these are unsuitable for them (Previous timescale of 31/01/08 not met). It is acknowledged that some progress has been made in this area. The registered person must 31/08/08 ensure that people are protected by robust recruitment and safe moving and handling techniques. The registered person must 31/08/08 ensure that the system of recruiting staff after return of a satisfactory povafirst but prior to the return of the full criminal record bureau check must not be routine practice and only used in exceptional circumstances. This will help to ensure that only suitable people work with vulnerable adults. The registered person must 31/12/08 ensure that staff members receive training appropriate to the work they are to perform, for example service specific training such as conditions affecting older people. This will ensure that the staff team have the skills and knowledge required to meet the full range of needs identified in assessments. It is acknowledged that dementia care training has been placed on the training plan. The registered person must 31/10/08 ensure that the system for reviewing services includes formulating action plans to address shortfalls identified in audits and surveys. It is acknowledged that the new system of quality monitoring has only just started. The registered person must 30/09/08 ensure that all records required DS0000070917.V368825.R01.S.doc Version 5.2 Page 34 9 OP18 13 10 OP29 19 11 OP30 18 12 OP33 24 13 OP37 19 Sycamore House 14 OP38 13(4) & 18 for the safe running of the home are in place and up to date. These must include the statement of purpose and service user guide, staff photographs, care plans and risk assessments. The registered person must ensure that all staff move and handle people in a safe way in line with their care plans. This will prevent any injuries to residents and staff. 31/08/08 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 2 Refer to Standard OP8 OP9 Good Practice Recommendations The manager should ensure that monitoring charts, obviously put in place for a reason, are completed accurately and consistently. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The temperature of all medication storage areas should be below 25°C. This makes sure that medicines are being stored at the temperature recommended by the manufacturers. In view of a comment made by a resident regarding their perception of choice about rising and breakfast arrangements this needs to be checked out to ensure people are fully aware of their choices and that these are respected. The registered manager should continue working towards completion of the Registered Managers Award. The manager should consider sending questionnaires to staff and visiting professionals for further consultation on the way the home is managed. The registered person should consider fire door stops to control doors that residents prefer to leave open instead of DS0000070917.V368825.R01.S.doc Version 5.2 Page 35 3 OP9 4 OP14 5 6 7 OP31 OP33 OP38 Sycamore House the unsafe practice of wedging doors open. Sycamore House DS0000070917.V368825.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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