Inspection on 30/09/08 for Sycamore Lodge

This inspection was carried out on 30th September 2008.

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

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

Other inspections for this house

Sycamore Lodge 04/12/07

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOME ADULTS 18-65 Sycamore Lodge 54 Greenheys Road Wallasey Wirral CH44 5UP Lead Inspector Helen Carton Key Unannounced Inspection 30 September 2008 09:15 th Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 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 Lodge DS0000069979.V367314.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 Adults 18-65. 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 Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Lodge Address 54 Greenheys Road Wallasey Wirral CH44 5UP 0151 638 7625 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) cath.keenan@alternativefuturesgroup.org.uk Alternative Futures Catherine Keenan Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with Nursing- code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of people who can be accommodated is: 12 Date of last inspection 4th December 2007 Brief Description of the Service: Sycamore Lodge is a single storey building separated into two units. Both have their own lounge, kitchen and bathroom areas. Specialist lifting and bathing equipment is available for use by service users. All bedrooms are single occupancy. There is a car park area to the front of the building and two separate garden areas at the rear for service users use. A copy of the most recent Commission for Social Care Inspection (CSCI) report is available from the manager of the service. Alternative Futures who own and run Sycamore Lodge will provide information about inspections on request. At the time of the site visit the deputy manager was unable to provide information about the fees charged as they are currently being reviewed. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of the inspection process we sent Sycamore Lodge an Annual Quality Assurance Assessment (AQAA) document, which was to be completed prior to the site visit. This document was to provide information about the service at Sycamore Lodge and to tell us where they felt they had made improvements to the way they support service users and the staff team. The manager completed and returned the document before the site visit took place. We visited Sycamore Lodge to enable us to look at records and to discuss how the service supports service users in all aspects of their lives. Part of this process involved speaking with different managers, members of the staff team and spending a little time with some of the service users to find out their views on living at Sycamore Lodge. We spent approximately nine hours at the service. As part of the inspection process surveys were sent to service users and members of the staff team to gain their views of the service being offered, a total of two responses were received. What the service does well: Members of the staff team spoken with showed an understanding of their roles and responsibilities and were positive about the relationships they have with service users. We observed members of the staff team supporting service users in a caring and sensitive manner. Service users appear to be comfortable and relaxed during our visit to Sycamore Lodge. The managers and the staff team are currently working hard to support service users to move on to more independent living environments. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 6 Service users have their own bedrooms, which are personalised to reflect their interests. The management team are keen to improve the service at Sycamore Lodge and reacted positively to issues raised during a site visit. What has improved since the last inspection? What they could do better: Sycamore Lodge is owned and run by Alternative Futures, which is a registered charity. The service has a full range of policies and procedures to support the managers and the staff team however there appears on occasions a lack of consistency in applying these policies into practice. Work needs to be done to ensure policies such as medication, staff records including training completed, and health and safety issues is consistently applied by all members of the team. This approach will promote service users safety and overall wellbeing. There has been improvement in the support plans around the daily routines and social and emotional needs of service users. However further work is Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 7 needed on nursing care support plans to ensure up-to-date and accurate information is recorded. Such as administering medication and food supplements as required by GPs and other heath care professionals and recording these activities. This is to ensure the staff team feel confident that the support they are providing is safe and promotes service users physical wellbeing. Risk assessments and behavioural support plans provide the staff team with detailed information about how to support and supervise service users who are presenting with physically challenging or risky behaviours. However risk assessments had not been completed where service users were regularly being affected by the aggressive behaviour of other service users. There appears to be at times a lack of awareness by the service as to the impact living in an aggressive and unpredictable environment can have on an individuals emotional and mental state. Information we gained from completed surveys, discussions with the management team and members of the staff team. Showed at the time of the site visit the service was experiencing difficulties providing adequate staff to meet the holistic needs of service users. This impacted on the ability of service users to access community facilities and activities limiting their ability to make positive choices about how they spent their day. During the site visit the area service manager made arrangements for agency staff to cover any shortfalls in the staffing rota. 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 Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre- admission assessments carried out by the service identifies the care and emotional needs of prospective service users. EVIDENCE: Since we last visited the home the manager has reviewed the pre admission assessment tool to make sure it looks at the emotional and social needs of prospective service users. This information was gained from the completed AQAA dataset provided by the manager prior to the site visit. The amendments made to the assessment tool will ensure consideration of individual need, concerns and anxieties of prospective service users and their families can be addressed. This approach will support the staff team to enable them to develop positive relationships and safe physical support with service users who have decided to make Sycamore Lodge their home. There have been no admissions to the home since our last visit however there still remains a number of service users who require a different environment and levels of support than Sycamore Lodge can provide. Resulting in the needs of individual service users having a negative impact on the quality of life of the other people who live with them. These issues were identified during the last site visit since then the management team have been working with Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 10 other agencies to ensure these service users are offered appropriate and safe support in environments that suit their needs. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 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 management strategies do not adequately support service users to live their lives as they choose. EVIDENCE: We looked at a sample of service users support plans the following issues were discussed with members of the management team. The management team have reviewed how they record information about service users. With more information about service users emotional and social needs being recorded including relationship maps, communication plans and activity programs. This information is vital for the staff team to be able to offer appropriate, safe and enabling support particularly as many of the service users who live at Sycamore Lodge have limited verbal communication abilities. The nursing care needs of service users are clearly identified however more work is needed to ensure clear guidance and where necessary instruction is Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 12 documented for the staff team. This is to make sure service users health care needs are proactively managed to enable them to remain as active, independent and free from risk or harm. The acting manager told us she had already identified this and was in the process of reviewing medical and nursing care support plans. We discussed with the management team the need to make sure support plans, behaviour management plans and reviews are dated and signed. Without this information it is difficult for the management team to effectively review, monitor and where necessary seek specialist support for service users presenting with risky or challenging behaviour. It is important that support plans are used as working documents and consistently reflect the care and support being delivered. This will ensure service users receive individualised support rather than a generalised care service. Daily records provide adequate information about service users daily routines and activities. However when incidents of risky or challenging behaviour had occurred detailed information was only recorded on the daily record of the person presenting with the behaviour. The impact this behaviour had on other service users was not recorded resulting in a limited review of incidents taking place. This gap in information could lead to a lack of awareness by the service of the impact living in an aggressive and unpredictable environment can have on other service users emotional and mental wellbeing. There were a number of risk assessments and behaviour support plans in place with detailed information about the techniques to be used if a service user became physically aggressive. However were a service user was known to target another with physical aggression there was no risk assessment or support plan in place. We discussed this with members of the management team who told us they would review these incidents and ensure risk assessments were undertaken and where necessary support plans put in place. We looked at a number of risks assessments and daily record entries, which indicated the number of staff, required to safely support individuals in specific tasks such as accessing the community. We looked at the staffing level that showed on most days there where not enough staff to support service users to access the community. We discussed these issues with the area service manager of the organisation and the impact this will have on service users sense of wellbeing. He told us that as a provider in the Wirral they were experiencing difficulty recruiting support workers. Also as some service users are due to be moving out in the next few months this had also created problems. He told us he intended to arrange for agency staff to be brought in as soon as possible to cover any shortfalls. He confirmed this action had been taken and that agency staff would commence work the following day. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 13 Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are unable to live their daily lives as they wish due to staffing shortages. EVIDENCE: We looked at a sample of service user support plans, which showed the activities and hobbies service users enjoy. Daily records confirmed in-house activities take place regularly including drawing, listening to music, helping with household tasks and supporting service users with sensory activities. However daily records also showed the ability of service users to access community-based activities limited due to the staffing support needed by some service users who have complex behaviour needs. We discussed this issue with the management team the area service manager told us he intended to cover staff sickness and staffing vacancies with agency staff. This action will support the staff team to promote individual independence and the right for service Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 15 users to live in a flexible environment where their choice of routines and activities are when possible met. Support plans provide detailed information about the relationships that are important to service users. These include family relationships, health care professionals and key worker relationships and friends. This information is very important as many of the service users rely on the ability of the staff team to understand their body language as to whether they are happy and comfortable in their daily lives. We spoke to a number of the staff team they were very respectful and sensitive to the needs of service users. They acknowledged at times supporting some individuals could be challenging however they all felt service users were treated as individuals and respected citizens. From the AQAA dataset, returned surveys and the staffing rota we noted the service accepts a large number of student nurses on a rotation basis to work within Sycamore Lodge. Resulting in service users having to get to know a large number of people throughout the year who would need to support them in their daily lives and with their personal care needs. We advise the management team to review the number of students accepted as part of their training and ways in which service users can be involved in this decisionmaking. We looked at information about service users nutritional needs including foods people liked or disliked. A number of service users receive their nutritional needs in liquid form through a Percutaneous Endoscopic Gastronomy (PEG) tube. We looked at information about what food supplements service users had been prescribed and also the amount and flavours on offer to give them some variety. These records were poorly kept with members of the staff team not recording when food supplements were given. The lack of records prevents the management team from reviewing the effectiveness of the nutrition provided and could lead to service users being malnourished. We discussed this issue with members of the management team who agreed to review the current poor practice and put in place procedures to ensure detailed records are kept. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are left at risk of receiving inadequate nursing and physical care support due to the lack of detailed information held in nursing support plans. EVIDENCE: We looked at a sample of support plans, which provided detailed information about how service users would prefer to be supported with their personal care needs. This included information about favoured toiletries including hair colours, shampoos and deodorants. Information was provided about personal routines such as the time an individual likes to have a bath, how to support someone to wash themselves and the level of support needed to help them wash their hair. Records show service users are supported to access health care services such as dentist, opticians and podiatry. Records also show that overall health needs are monitored and appropriate action and intervention is taken. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 17 Nursing care support plans are in place however the information provided in them was limited with little guidance or instruction available to the staff team. This leaves service users vulnerable to receiving inappropriate and unsafe care, which may result in health care conditions deteriorating. Such as the use of equipment to prevent pressure areas developing on the skin that is no longer recommended by the Royal College of Nursing. The service was also using bedrails without a policy or procedure in place. We noted blankets and quilts were being used as protective covers on two sets of bedrails rather than the appropriate protectors. During the site visit the area service manager had these removed and appropriate protectors fitted. Since the site visit the area service manager has forwarded a policy and procedure for the use of bed rails and their protector covers, which now offers service users protection from the possible misuse of this equipment. The acting manager told us she had already identified the need to review all medical and nursing care support plans and had arranged for a meeting with the nursing staff early next week. All guidance and instruction will reflect current good practice ensuring service users receive consistent and appropriate support. The service uses a monitored dosage system to administer oral medication to service users. The qualified nursing staff, administer service users medication and manage the medication systems within Sycamore Lodge. We looked at a sample of Medication Administration Record (MAR) sheets a number of issues of concern were raised with the management team. Medication prescribed by a service users GP had not been administered in line with their instructions. Ointment and cream medications detailed on the MAR sheets had not been signed as administered. Food supplements entered on the MAR sheets had not been signed as administered. We told the acting manager and the deputy we would request a pharmacy inspector visit to fully inspect the medication system within the service. The acting manager told us as a matter of urgency she would review the recording and administration of medications to ensure they are in line with the organisations very detailed medication administration policy and procedures. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are adequately safeguarded from abuse. However some poor care practices could leave service users at risk of receiving inappropriate or neglectful care. EVIDENCE: The service has a detailed complaints procedure with timescales for action and responses to concerns raised. There is also a shorter version that is made available to service users and their family/advocates. The AQAA dataset shows the organisation is currently reviewing the complaints procedure to produce it in an easy read format. This is to ensure this information is easily accessible to service users who live at Sycamore Lodge. Since the last site visit three complaints have made to the manager regarding the care and support provided to service users. Records show all complaints were proactively managed with satisfactory outcomes for all parties. There are policies and procedures regarding the safeguarding of vulnerable people, members of staff team spoken with showed a clear understanding of their roles and responsibilities regarding safeguarding the service users living at Sycamore Lodge. However the lack of detailed records kept about food supplements given, gaps in the medication records and poor care practices such as the use of bed rails without a policy and procedure and outdated nursing practices indicates not all members of staff team understand the different forms of abuse such as neglect. We discussed these issues with the Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 19 management team who acknowledged work was needed to ensure all members of the staff team understand their roles and responsibilities. Records show the manager and deputy manager proactively manage concerns or allegations of abuse raised with them referring them on to Wirral adult social services safeguarding adults team. Where necessary the manager has referred ex-members of staff to the Protection of Vulnerable Adults (POVA) list to prevent them working with other vulnerable people. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall Sycamore Lodge provides an adequate living environment for residents’, which meets their physical needs. EVIDENCE: Sycamore Lodge is a purpose-built single storey building. It has been split into two units one supporting four people the other supporting seven. Both areas have a lounge dining area and all service users having their own bedrooms, there are adequate bathrooms and separate toilets. Each unit has a kitchen area however there are full-time catering staff who prepare all the main meals in a central kitchen away from the units. We did not look around one of the units as some of the service users were presenting with challenging and risky behaviours and it was felt our presence might cause them further anxiety and stress. The areas of Sycamore Lodge we did visit were clean and on the whole tidy with service users bedrooms reflecting their interests and tastes. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 21 Examination of support plans showed that for a number of service users the environment was not meeting their care and emotional needs. Members of the senior management team told us these issues has been discussed in multidisciplinary meetings resulting in alternative placements being identified for these service users. We noticed that service uses wheelchairs were being stored in the main corridor of one of the units this looked very untidy and not particularly homely the deputy manager was asked to review how wheelchairs are stored. In the main entrance hall old bedroom furniture was being stored the deputy manager agreed to have it removed. Specialist equipment is available to support residents with a personal care needs including hoists, shower beds and specialist seat to ensure service users comfort and safety. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 & 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The current staffing levels do not meet the needs and expectations of service users. Leaving them at risk of receiving inadequate care and support. EVIDENCE: We looked at a selection of staff records the following issues were discussed with the management team. One record had no information in it other than the employees name we asked the deputy manager to find out if the relevant safety checks had been made. We received the following information an enhanced Criminal Records Bureau (CRB) check had been carried out, two references has been taken up and the person was employed for 37 1/2 hours as a nurse. There was no written evidence that an induction programme had been started. The deputy manager told us this person had commenced employment on the 22nd of September 08 we acknowledged at the time of our visit this person had only been working for one week. However basic information about the checks made and an induction checklist detailing what information had been given should be present in the staff record. This is to ensure the employee has the appropriate information to Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 23 allow them to feel confident in supporting the service users they are working with it also offers service users protection from being supported inappropriately or in an unsafe manner. A second record looked at provided information about competency levels reached regarding specific tasks to be undertaken such as peg tube feed procedures. It also had a sign off sheet, which showed that the member of staff had read and understood the policies and procedures used at Sycamore Lodge. However as detailed earlier information about the checks made prior to employment were not available. The deputy manager told us these types of records were held at the organisations head office. We advised her that a copy of these checks must be held at the service this is to ensure the registered manager and provider can demonstrate all reasonable precautions have been taken to safeguard service users from neglect and abuse. The area service manager told us all employees of the organisation have their CRB checks renewed every three years. This shows a commitment by Alternative Futures to take all reasonable steps to protect service users from possible abuse. As a care home that provides nursing care, qualified nurses are employed records viewed did not provide up-to-date information about whether some of the nurses had renewed their registration with the Nursing and Midwifery Council (NMC). The acting manager told us it was the nurses responsibility to provide the service with the information regarding their registration with the NMC however this would now be followed up and all records updated. Records show the organisation is committed to providing training to enable staff team to support service users appropriately and safely. However due to the current staffing levels the ability of the staff team to undertake training would be limited. This situation will impact on the quality of the support and care provided to service users. A number of comments were made in completed surveys that indicate there are concerns that training provided by the organisation does not reflect the changing needs and the specific care needs of service users. All people who completed surveys for us stated they enjoyed supporting service users and felt the support they offered was of a good standard. We spoke with members of staff team who all demonstrated a commitment to supporting service users appropriately and safely. Overall they enjoyed their work however issues around staffing levels had impacted on their ability to support service users to take part in a variety of activities, particularly those in the community. These views were confirmed in surveys returned to us. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 24 Members of the staff team are currently supporting some service users who presents with challenging and risky behaviours, which means they can be working in a highly stressful and aggressive environment. The staff rota shows members of the staff team have been working excessive hours to cover sick leave, annual leave and staff vacancies. This situation leaves the staff team at risk of not performing at their best and not supporting service users who are presenting with challenging and risky behaviours safely and appropriately. We discussed this concern with the area service manager who confirmed agency staff would be brought in to cover shifts and to support the staffed team through this difficult period. The deputy manager told us she had been involved in interviewing prospective staff on the day of the site visit however a number of candidates had just not turned up. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40,41 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in some of the management systems and maintenance of records impact on the level and consistency of care offered to service users living at Sycamore Lodge. EVIDENCE: The registered manager is currently off sick leaving the deputy manager in day-to-day control of the service. As added management support an experienced nurse manager has been seconded to work with the managers to improve performance in specific areas. Information provided in the AQAA dataset indicates the organisation has audit systems in place. Which include customer satisfaction surveys and feedback from other stakeholders such as the staff team, community health teams, visitors and independent advocates. However this activity is not always Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 26 incorporated into the daily workings of the service. For example equality and diversity training handbooks have been sent to the service in line with the organisations training requirements. These handbooks have not been passed to the staff team with any assessment being undertaken by the management team about their awareness and understanding of these issues. The area service manager carries out and audit of the service on monthly. Sycamore Lodge has detailed policies and procedures, however during our site visit we noted that on a number of occasions management and care practices did not always reflect them. Such as the medication policy and procedure, staff support required by individual service users as detailed in their support plans not provided and poor staff records. Policies and procedures must be consistently applied to ensure service users receive safe, consistent and appropriate support at all times. These issues were discussed with the management team who acknowledged work needed to be done to ensure a consistent approach was provided to both service users and the staff team. A sample of health and safety records were looked at most of the records were well kept. However the medication fridge and portable defibrillator record had not been signed as checked on a regular basis. Some service users sleep on pressure relieving mattresses there were no records to show who had been involved in the decision to use these mattresses and what the desired outcome was to be. During the site visit the deputy manager made a referral for formal assessments for the service users to the occupational therapy department of the local hospital. The staffing rota showed on a number of occasions members of the staff team have been working excessive hours up to 16 hour shifts to cover sickness, annual leave and staff vacancies. Allowing members of the staff team to work such long hours has a negative impact on their well being and the quality of care and support they offer to service users. As detailed earlier in the report the area service manager arranged for agency staff to cover any staffing shortfalls. Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 27 Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 2 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 2 2 2 X Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 Timescale for action Care planning systems within the 30/11/08 service must provide detailed and consistent information about the nursing care needs of service users. This is to ensure they receive appropriate medical treatment and support at all times. Risk management strategies must be adopted to support those service users witnessing or being the victims of physical aggression. This is to ensure service users receive adequate protection and support during these incidents. When a risk assessment indicates a specific number of staff is required to support an individual service user in the community the registered provider must provide that staffing ratio. Or seek a formal review indicating they can no longer meet their needs. 30/11/08 Requirement 2. YA9 13 3. YA13 13 30/10/08 4. YA16 15 Information held in support plans 30/11/08 DS0000069979.V367314.R01.S.doc Version 5.2 Page 30 Sycamore Lodge regarding residents preferred routines must form the basis of the care and support offered. With particular regard to being supported to maintain an active lifestyle. 5. YA17 16 Records about the type and amount of food service users receive through their PEG tube must be recorded. This is to ensure they receive adequate nutrition in a variety of flavours. 30/09/08 6. YA19 13 Nursing care practices must be 30/09/08 regularly reviewed to ensure they reflect current good practice and do not have a detrimental effect on service users physical wellbeing. With particular regard to skin care and pressure area support. Medication must be administered to service users as directed by the prescribing GP. With detailed records being kept to reflect their actions. This is to ensure service users health care needs are effectively managed. A review of the training being offered to the staff team must take place. This is to ensure they are skilled and confident to offer support to service users with specific needs such as PEG tube feeding, tissue viability care and how to maintain records. Excessively long shifts (16 hours) should not be worked due to the detrimental impact on the member of staff and the effect on the quality of care and support offered to service users. Staff records must be well DS0000069979.V367314.R01.S.doc 7. YA20 13 30/09/08 8. YA32 18 30/12/08 9. YA33 13 30/09/08 10. YA34 19 30/11/08 Version 5.2 Page 31 Sycamore Lodge maintained and available for inspection when required. This is to ensure the service can demonstrate they are proactively safeguarding residents from being supported by people who do not posses the skills and expertise required to work with vulnerable people. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA23 Good Practice Recommendations Work should be done with the staff team to enable them to recognising the different forms of abuse including poor care practices. The organisation should review the number of student nurses and the frequency at which they carryout placement at the service. This is to ensure this practice does not have a negative impact on service users who consider Sycamore Lodge their home. The organisation should ensure they effectively audit the service to ensure actions to be carried out have been. Such as the distribution of the equality and diversity handbooks. The working practices of the service should reflect the guidance of Alternative Futures policies and procedures. This is to safeguard service users from possible neglect and abusive practices. The service should review the way in which information is recorded to ensure information is dated and provides detailed information about significant events. This is to make sure care and support plans can be effectively reviewed to ensure service users changing needs are met. DS0000069979.V367314.R01.S.doc Version 5.2 Page 32 2. YA33 3. YA39 4. YA40 5. YA41 Sycamore Lodge 6. YA42 The registered provider with the manager should review staffing levels regularly to ensure they can safely meet the needs and expectations of service users daily living needs. Health and safety records should be maintained at the required intervals to ensure service users and the staff teams safety. 7. YA42 Sycamore Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Lodge DS0000069979.V367314.R01.S.doc Version 5.2 Page 34 - 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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