Inspection on 20/06/05 for Sycamore Lodge Care Home

This inspection was carried out on 20th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sycamore Lodge Care Home 24/07/07

Sycamore Lodge Care Home 24/04/06

Sycamore Lodge Care Home 27/09/05

Sycamore Lodge Care Home 04/02/05

Sycamore Lodge Care Home 17/06/04

Sycamore Lodge Care Home 02/12/03

Sycamore Lodge Care Home 02/06/03

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Sycamore Lodge Care Home 3 Hardy Street Nottingham NG7 4BB Lead Inspector Linda Hirst Unannounced 20 June 2005 09:30 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 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 Stationary 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 Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Sycamore Lodge Nursing Home Address 3 Hardy Street Nottingham NG7 4BB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 9784299 No fax Mrs A Khan No-one registered Care Home with Nursing 16 Category(ies) of Learning Disability - 16 registration, with number of places Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 4/2/05 Brief Description of the Service: Sycamore Lodge is a converted victorian property in its own grounds, situated in Hardy Street in Nottingham. The home is registered to provide nursing care for up to 16 residents with a learning disability. The accomodation covers two floors and there are both single and shared bedrooms available. There is a vertical lift to provide access to the upper floor for residents with mobility difficulties. There is a minibus available for some of the time and at other times transport is arranged by hiring a minibus and driver. Both forms of transport incur costs for the residents using it. The home is a five minute walk from shops for a person with good mobility and there are public houses, restaurants, places of worship and access to local transport within Hyson Green itself. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was prompted by two allegations of abuse on residents by staff. The visit was not announced and took place over a whole day involving three inspectors. The main method of inspection used was called ‘case tracking’ which involved selecting four residents and tracking the care they receive. Some of the people who live at this home have a very limited ability to understand and communicate. Therefore some of the judgements in this report are from observation and reading residents’ records and documents. The residents themselves were not able to help in this process. 3 staff who work at the home were spoken with to see what training and support they get with their jobs. What the service does well: What has improved since the last inspection? Some staff have had training on working with people with learning disabilities to make sure they can understand and meet the needs of people living at the home. Staff now talk to residents in their own language so that they can understand what is being said. Staff have been given clear guidance about how to help people to eat in a caring and sensitive way and they are acting on this. The residents’ financial records are now kept at the home and can be seen by residents or their relatives with permission. The heating system has been repaired and the home is warm. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 5 The statement of purpose and the terms and conditions of residents are not clear or explicit about the service residents can expect. They are inaccurate documents which lead to residents paying more than anticipated for the service received. EVIDENCE: The statement of purpose and the terms and conditions of residence were checked to see if the arrangements for residents paying for transport and meals out as part of the in house day service package were clear. They were not made clear in either document meaning those who fund service users are not aware of the extra costs that residents are funding from their benefits. Although it is only those who use the transport who pay towards the cost of the journey, the costs are not auditable as the residents are not charged per mile. If residents are to be charged for transport it must be at an identified price per mile to ensure they pay a fair amount. It is also recommended that the actual cost of the in house day service be explicit on the contract rather than being “negotiable.” These matters will be raised with the Commissioning and Contracting team at Social Services as they may be of direct concern to them. The statement of purpose does not contain the information and documentation specified in the law and it can not fulfil its purpose as a document of Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 9 inspection. This must be addressed and the provision of the service made explicit. After the last visit to the home an immediate requirement was set for all staff who had not been on specialist training about people with learning disabilities to have this provided. Some of the staff interviewed have now received this training, others have not and it must be provided to ensure staff are clear about the needs of the people living at the home. Another requirement was set after the last visit that the registered provider must ensure that all staff treat residents with respect. On arrival at the home, several residents were seen walking around with bare feet or in socks. This demonstrates a general lack of concern for the comfort of residents. On two occasions residents who needed blended diets were heard being referred to as “the softies,” this is inappropriate language demonstrating a lack of respect for the dignity of residents with special needs. The Registered provider must ensure that these issues are formally addressed and resolved with staff, and staff must sign to confirm they have received and understood the training and guidance provided. See comments under care planning and supervision of staff. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 Care plans are well written and detail the residents needs and how these should be met. However, successful strategies for managing behaviour are not always translated into action and there is no evidence that the responses of staff are checked by the manager to make sure they are appropriate. This places residents at risk of abuse. EVIDENCE: Care plans were inspected and were found to be generally well written and detailed, giving staff clear directions on how to meet the residents’ needs. However there is no evidence that monitoring takes place to check that staff are following these plans. Robust monitoring and feedback systems must be put in place to make sure that this occurs. This is an outstanding requirement from the last visit and must be resolved if enforcement action is to be avoided. Behaviour is assessed and there are detailed care plans in place for supporting people when their behaviour is challenging. In one instance, a method of diverting a resident when she is challenging has been found, but this has not been translated into a care plan so that staff can try a method which has proved successful. Behaviour is monitored using Antecedent, Behaviour, Consequence charts, but those seen were not always completed meaning Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 11 behaviour is only being monitored for some of the time, this does not provide a consistent approach. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16, 17 Residents access the community and activities are provided for residents but at some considerable cost to themselves which in some cases is not acceptable. One relative expressed her satisfaction with the care provided at the home and said she could visit at any time. Some staff are failing to respect the dignity and comfort of residents and this issue must be addressed. The food provided to residents is not healthy enough and their access to drinks must be improved to maintain their health and wellbeing. EVIDENCE: Most of the residents have their day services provided by the staff at the home. They employ a person to facilitate activities. The activity log sheets were inspected for the residents who were “case tracked,” one had only one weekday activity recorded, one had activities recorded on four days and one on two days. Activities provided in the past week include, pub lunches, going to Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 13 the coffee shop and music therapy. The residents are paying for their own meals when they go out, but this should be provided as part of the day service and this issue will be referred to Social Services Contracting. The residents also pay for the transport, which is either using the minibus at the home or hiring one with a driver. The residents are not charged at an identified mileage rate for either trip and this should be the case to protect their interests. Residents go out into the local community and this was confirmed by observation on the day (residents were seen going out for a walk) and by the comments made by staff. One of the residents said he goes to church regularly. A relative was interviewed as part of this inspection. She said she is happy with the care provided and feels she can visit the home at any time. She said she is invited to barbecues and other celebrations. She said her relative stays in bed until late and decides himself whether to go out on trips. The lunch was observed, the menu for the day was rice and chicken and mash for those needing blended diets. The food looked appetising. All of the residents had disposable plastic aprons around them whilst they ate to protect their clothing. Residents were assisted to eat by staff sitting alongside them and the staff explained what they were having. This is good practice. There is a “seating plan” displayed on the kitchen door which lists the people who should have their lunch first. It also states that tables should be properly set with condiments and wipes. Wipes were available on one table, but not on any others, no condiments were available and no drinks were served with the meal. This is concerning as the weather on the day of the visit was very hot and sunny. The staff must ensure that residents have an adequate fluid intake, especially during hot weather to maintain their health and wellbeing. There is a daily record of the food eaten by the residents but these sheets are not fully completed and the monitoring of the food intake of residents is therefore not consistently done. The residents are not having fresh fruit and vegetables every day and this is required to maintain the health of residents. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 Residents’ health needs are well assessed in the care plans. The medication practice is not safe and compromises the health and wellbeing of residents. EVIDENCE: One resident’s records indicated that he has Diabetes and his blood glucose levels should be monitored every other day. The care plan states the normal reading range for the resident and this is good practice. Residents were taken on the day of the visit for chiropody treatment. The visits should be recorded as evidence that staff are maintaining residents’ health. The lunchtime medication round was observed at 12.30 and it was noted that none of the tablets given out in the morning had been signed for by the manager. This is not acceptable, there must be evidence that medication is given to residents as prescribed as soon as it is given to avoid any error. The medication for one service user was dispensed incorrectly and the excess was disposed of down the sink. One of the residents who was “case tracked” is prescribed tranquillizers as required, but there is no evidence of guidance to staff about the circumstances in which this medication should be administered so that they are not giving medication unnecessarily. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 15 One of the residents had sunburnt arms, this was queried with the manager who said that most of the residents are sensitive to the sun because of the medication they take. A record was seen which indicated the staff applied sun block, but the time of application was not indicated, nor was there any indication that it was reapplied at intervals during the day to offer her ongoing protection. Staff should record the time sun block is applied to evidence that they take all appropriate steps to protect the residents from burning. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The staff are not fully aware of what constitutes abusive practice, nor are they clear about reporting and whistleblowing. The residents are at significant risk of abuse or harm because of these failings and there have been three abuse allegations since the last inspection. The providers and manager are failing in their obligation to keep residents safe from harm. EVIDENCE: The complaints record was inspected, three were recorded all of which pertained to abuse allegations. The record of complaints was incomplete as the records of the investigation by the proprietor were not held with the complaint records. Without these it is not possible to determine whether the providers take complaints seriously and respond with appropriate action. Since the last inspection there have been three allegations of abuse of different residents by members of staff. Indeed, this visit was prompted by two allegations of abuse. Two members of staff are currently suspended pending investigation of these issues. One member of staff allegedly involved in one incident was interviewed as part of this inspection and gave an account of what happened on the day in question. As these incidents are still under investigation no further comments can be made. Two members of staff have been dismissed following two previous allegations of abuse, both incidents have been investigated by the Police and one case is going to Court. A decision regarding the other is awaited. Where the proprietors have taken action to suspend staff when incidents come to light the frequency of incidents and the lack of proactive measures to reduce the incidence of alleged abuse is of great concern and must call into question how the home is being run and managed. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 17 Most of the staff have attended training on abuse, but none of those who were interviewed were fully aware about what constitutes abuse or their obligations to report. One staff member was unclear as to whether staff were allowed to lose their temper with residents and it was stated that this does happen. One of the abusive incidents which has been investigated was witnessed by another member of staff at the home. This person has only just made a statement about the incident, some five months after the event. This clearly demonstrates that the whistleblowing procedures are not robust enough and staff fear the consequences of reporting. One of the residents was observed to have extensive bruising of her arm, the bruises being of different ages. This was queried with the manager and the home’s records were inspected. There was reasonable explanation for the bruising, no body map in place (although these are used at the home) to indicate the placing, pattern and dates of bruising and the bruising had not been reported. This indicates very poor management and oversight of the residents’ health. By failing to record and report on unexplained bruising the staff place the residents at significant risk of abuse. The residents’ financial records are now held at the home as required and were inspected. The proprietor’s husband (who is not registered) is the appointee for all of the residents and a signatory on all of their accounts. His Criminal Records Bureau check should be held on the premises for inspection but this was not the case, it must be sent to the Nottingham office of the Commission for Social Care Inspection without delay to check his involvement is appropriate and to protect the financial interests of the residents. With the exception of three residents all of the people living at the home have their own bank accounts which attract interest. Their benefits are paid directly into the bank and amounts are withdrawn for their personal use and held at the home. Several things were noted about these arrangements. • • If the residents go out for a meal or to a coffee shop the bill is split, rather than residents being charged only for the amount they spent. This is not acceptable and leaves them vulnerable to financial abuse. The money of residents is not held individually but pooled, and this makes it difficult to check balances, indeed the amounts held in cash and the balance totals did not tally. Residents’ money should be held individually to enable easy monitoring. The residents who share a joint account must have statements which indicate the credits, debits and interest payments to each individual to ensure their financial interests are protected. • Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 The environment is not clean or well maintained. It does not provide a comfortable and safe place for residents to live and in several cases it places their health and safety at risk. EVIDENCE: There were many areas of the environment needing attention, decoration, cleaning or repair to provide a safe and comfortable environment for residents. These are listed below: • • • • • • A dining room chair was broken and requires repair or replacement The carpets in the main lounge, small lounge and dining room were dirty and stained, the small lounge carpet had an iron burn mark on it.. The walls in the main lounge needed redecoration. The television was broken and could only be operated by switching it on and off at the mains, this is potentially dangerous, especially for residents who may not understand basic safety precautions. The chairs in the lounge were vinyl and needed cleaning, two of the chair cushions were stuck to their bases. The door panel in the main lounge was broken. C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 19 Sycamore Lodge Care Home • • • • • • • • • • • • The staff and residents had a barbecue 2 days previously, the barbecue equipment had not been cleaned. Charcoal, barbecue lighting fluid, a large sun umbrella, discarded tissues and a torn newspaper had been left on the lawn. The cupboard which stores residents’ toiletries is dangerous, the shelf sags and is sited next to the toilet, items could easily fall on to people using the toilet. It must be made safe. The light above the sink in the toilet is broken, the plastic casing is sharp and requires replacement to prevent cuts and injury. The emergency pull cord in the ground floor bathroom is broken and not retractable, making it difficult for staff and residents to summon help in an emergency. The locks to the ground floor bathroom and toilet have been removed to prevent a resident locking themselves in. This action impacts negatively on the rest of the residents and must be reviewed. The tap in the ground floor toilet is broken and needs repair or replacement. The first floor communal toilet was soiled with faeces and needs regular checking and cleaning to prevent cross infection. One of the fly screens (by the door) in the kitchen was open enabling flies to potentially contaminate food. The kitchen floor was dirty and needed cleaning. The ground floor bathroom is partially carpeted around the toilet, this is dirty and frayed. The toilet brush in the ground floor toilet is exposed which can lead to cross infection and it is attached to a pipe with a piece of string. This is unhygienic. There was no toilet roll in the toilet for residents to use and no approved safety lock on the door to protect the privacy and dignity of residents. The door to the small lounge (off the dining room) was blocked by a chair making access difficult and hazardous. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35, 36 The recruitment practice of the care home is not adequate and the systems to protect residents are not robust enough and place residents at risk of harm and abuse. Staff are not suitably trained or supervised in the work they undertake with residents. This places residents at risk of harm. EVIDENCE: One of the staff interviewed was a newly appointed driver. She is assisting with things which are beyond her remit and which she is not trained to undertake. (E.g. helping people to eat, taking residents out for walks and assisting with moving and handling). She has not had training on basic care practice, abuse, working with people with a learning disability or moving and handling. This member of staff is exposing herself and the residents to risk by undertaking tasks she is not trained to do. It was stated that the manager asks her to help out in situations and she feels unable to refuse. The manager must establish the limitations of this person’s role and these must be explained and adhered to. Other staff said they had been given training on all statutory courses and had in-house training on supporting people with challenging behaviour, this statement was supported by the training records seen. Given that allegations Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 21 have continued to be made the staff clearly need more formal training in supporting people with challenging behaviour, restraint and further abuse training is needed for all staff to make sure they are clear about best practice and their obligations. There is an outstanding requirement for all staff to have training regarding the needs of people with learning disabilities, and where there is evidence that some staff have had this training, of the three staff interviewed none had attended the training, although one had previous experience with this resident group. There are a number of oversees nurses working at the home. When the recruitment of staff from oversees was discussed with the manager she stated that no-one from oversees had been employed since she was in post and one adaptation nurse had done her training with her previous employer. However, one of the adaptation nurses was interviewed and stated he had arrived in England in January this year (when the manager was in post) and had done his adaptation training at Sycamore Lodge with the manager as his clinical supervisor, there is clearly a disparity between these accounts. This calls into question the integrity of the manager. The files of two members of staff were inspected, they did not have the documents and information required to ensure the protection of residents. The Criminal Record Bureau (CRB) checks of two staff indicated that they had previous convictions. The manager had not asked the staff members about these convictions and did not know the exact nature of the offences. This practice is highly dangerous and leaves the residents open to potential abuse. Staff with previous convictions should be given the opportunity to explain the circumstances and the manager and proprietor must then take a view as to whether their continued employment will put residents at risk of harm. . There was a letter dated over a year ago from the umbrella body who undertake CRB checks for the home which indicates that there are still 4 staff working unsupervised with residents who have had no CRB checks. There is no evidence that the manager has followed this up, and this is absolutely unacceptable, placing residents in a position of vulnerability. None of the documents for the most recently appointed member of staff could be found, including her CRB check. In addition, there was no evidence of the manager undertaking checks with the Nursing and Midwifery Council (NMC) that qualified staff’s PIN numbers were still valid and they have not been struck off. These issues are very serious and call into question the fitness of both the manager and the proprietor in terms of protecting the interests of the vulnerable residents living at the home. During the interviews with staff only one person mentioned supervision, and said it occurred once a year. There is an outstanding requirement for staff to be monitored to ensure that they follow care plans when delivering care, it is difficult to see how this can be done effectively without regular formal supervision and monitoring feedback. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 41, 42, 43 The provider and manager cannot evidence that they are fit to own and manage the home in a way that protects the residents. There are key records missing from the home which are necessary to check that the welfare of residents is of paramount concern. The arrangements for the health and safety of residents and staff are inadequate and leave those living at the home at risk of injury or harm. EVIDENCE: There is a significant amount of evidence to suggest that the manager is failing to ensure that staff are working within their job descriptions and that they are responding to residents in an appropriate manner. There is a lack of proper monitoring and record keeping to ensure the service delivery is of a good quality and that residents are properly protected. The manager was off the premises shopping when we arrived at the home. The manager is not yet registered with the Commission for Social Care Inspection and the evidence Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 23 gathered during this visit calls into question her fitness to be registered to manage. Two members of staff have been dismissed following investigations into allegations of abuse. The records of investigation and disciplinary hearings were not available on the premises for inspection to check that correct procedures were followed in protecting residents. These must be forwarded to the Commission for Social Care Inspection for inspection and kept on the premises thereafter. There were serious concerns identified around health and safety issues and these place residents at significant risk. These matters are detailed below. • During this inspection, residents were seen being transported in wheelchairs which were not fitted with footplates. This could easily lead to injury and footplates should be fitted at all times, unless otherwise assessed by an Occupational Therapist or Physiotherapist and documented in the residents’ care plan. The internal corridor to the stairs was blocked by a carpet shampooer and three wheelchairs. This would compromise the safety of staff and residents in the event of fire. The occupational therapy room which staff say is used daily is a wooden building. There is no smoke alarm fitted in the room, no fire alarm and no emergency pull cord to be used by residents and staff in an emergency to summon help. It contains electrical equipment which has not been tested by an electrician for safety. The curtains drape over the electric fire presenting a significant fire risk. The room is not safe for use in its current state and residents must not be allowed to use the facility until there is evidence that it meets both fire safety and health and safety requirements. In the kitchen a plastic container had been placed on top of a hot grill which presents a significant fire risk. The food temperature charts and fridge and freezer temperatures are not being recorded consistently to make sure food is stored and served at a safe temperature. The latter two issues must be referred to the Environmental Health Officer for their recommendations. Products subject to the Control of Substances Hazardous to Health Regulations are being stored in an unsecured cupboard in the kitchen placing residents at risk of ingesting dangerous chemicals. The kitchen worktop has been damaged by the water urn and could harbour infection. The kitchen sink needed a thorough clean to prevent food contamination. The chicken prepared for lunch was not probed to check it was a safe temperature for serving. • • • • • • • The issues raised by this inspection are many and serious, the registered provider is failing to ensure that the home is being conducted in a proper Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 24 manner which protects the interests and wellbeing of service users. By failing in this fundamental responsibility the fitness of the provider is called into question. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 x 1 x 1 Standard No 22 23 ENVIRONMENT Score 1 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 1 Standard No 11 12 13 14 15 16 17 x 2 3 x 3 x 1 Standard No 31 32 33 34 35 36 Score x 1 x 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sycamore Lodge Care Home Score x 3 1 x Standard No 37 38 39 40 41 42 43 Score 1 x x x 1 1 1 C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 26 YES 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 1 Regulation 4(1)(a c), Schedule 1 12(1)(a & b) Requirement The statement of purpose must contain the information and documentation specified in Schedule 1. The Registered Provider must arrange for specialist training to staff who have not received this previously in relation to their work with people with learning disabilities. An immediate requirement was issued in this regard. (Timescale of 18/2/05 not met) The registered provider must ensure that all staff treat service user with respect. Written confirmation of the instructions given to named staff must be maintained. (Timescale of 25/2/05 not met) Care plans must be up reviewed regularly and accurately reflect the current needs of residents. The registered person must put robust monitoring systems in place to ensure that staff are putting into practice the actions prescribed in care plans. (Timescale of 15/3/05 not met) Residents must be given a wholesome, nutritious diet, Timescale for action 20/9/05 2. 3 20/9/05 3. 3 12, 4 1/8/05 4. 6 15 Immediate 5. 17 16(2 & 4) 11/7/05 Page 27 Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 6. 7. 20 20 13(3) 13 8. 22 22, Schedule 4(11) 9. 23 13(7)(8) 10. 23 13(6) 11. 23 13(6) 12. 23 13. 23 7, 9, 19, Care Standards Act 2000 Section II(3) 13(6) drinks with their meals and an appropriate fluid intake must be maintained at all times. Medication must be signed for as administered. Residents who have tranquillizers prescribed as required must have plans in place to guide staff about the circumstances in which the medication should be given. Where residents medication places them at risk of sunburn, there must be a record of the each time sun block is applied. The registered person must ensure that complaints received by the home must include copies of investigation and outcome with action taken detailed clearly. These papers must be held at the home and be available for inspection. All staff must receive formal training on abuse, restraint and supporting people with challenging behaviour. The registered person must ensure that all staff are fully aware of what behaviour consitutes abuse and their reporting obligations under the Protection of Vulnerable Adults Procedure and the homes Whistleblowing policy. All unexplained bruising must be fully documented, dated and reported. There must be proper management and oversight of the situation. The Criminal Records Bureau Check for the providers husband must be forwarded to the Commission for Social Care Inspection without delay. (Timescale of 18/3/05 not met). Residents money must not be pooled and money must only be Immediate 11/7/05 1/8/05 20/9/05 30/6/05 Immediate 1/8/05 Immediate Page 28 Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 14. 23 20 15. 24 23 16. 24 23 17. 18. 19. 20. 24 24 24 30 23 23 12(4)(a) 16(2)(j) deducted from residents balances which they personally have used or consumed. Bills must NOT be split. The statements for the residents who share an account must INDIVIDUALLY detail the credit, withdrawals and interest payments for each person. The following issues must be reapired or replaced to ensure the premises are kept in a good state of repair and equipment is maintained in good working order:1. The broken dining chair 2. The television 3. The door panel in the main lounge 4. The shelves in the cupboard housing residents toiletires 5. The light above the sink in the toilet 6. The emergency pull cord in the ground floor bathroom 7. The carpet in the small lounge The following areas must be cleaned to ensure the premises are fit for the purpose of achieving the aims and objevctives in the statement of purpose:1. The vinyl chairs in the lounge 2. The carpets in the main lounge and dining room. 3. The barbecue 4. The first floor communal toilet 5. THe kitchen floor 6. Thekitchen sink 7. The carpet around the toilet in the ground floor bathroom. Redecorate the main lounge The grounds of the home must be kept clean and safe. Fit approved safety locks to bathrooms and toilets Fly screens must be in place at all times 1/8/05 20/9/05 11/7/05 20/9/05 11/7/05 20/8/05 11/7/05 Page 29 Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 21. 22. 23. 24. 30 32 34 34 16(2)(j) 18 17, Schedules 2 and 4 19(1)(a & b) 25. 34 19 26. 27. 28. 29. 36 42 42 42 18(2) 13, 23 13 12 30. 42 13 31. 42 13 The toilet brush identified must not be exposed and must be in an appropriate storage unit. All staff must be suitably trained, qualified and competent for the tasks they are to undertake. Staff files must contain the information and documentation specified in Schedules 2 and 4. If staff have previous convictions the regsitered person must investigate the circumstances to assess whether the person is fit to work at the home. The CRB checks for staff which have been outstanding for over a year must be followed up without delay. There must be evidence of a portability check with the Nursing and Midwifery Council before they start work. Qualified and care staff must be appropriately supervised at all times. Wheelchairs must be fitted with footplates at all times. Corridors and access routes must be clear at all times. Obtain an assessment of the day care unit by the Fire Service and the Health and afety Executive. The facility may not be used by residents until the premises are assessed by them as safe for use. Seek and follow the advice of the Environmental Health Officer in relation to the following issues: 1. Storing items on top of the grill in the kitchen. 2. The frequency at which fridge, freezer and cooked food temperatures should be taken. All productssubject to Control of Substances Hazardous to Health Regulations must be secured at all times. 11/7/05 20/9/05 20/9/05 Immediate 1/8/05 1/8/05 11/7/05 11/7/05 30/6/05 11/7/05 11/7/05 Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 30 32. 33. 43 7, 26 The registered person must demonstrate their fitness to remain registered. 11/7/05 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. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Refer to Standard 1, 5 5 6 12 17 17 19 20 34 32 42 Good Practice Recommendations Residents should be charged for transport in a fashion which enables equity, auditing and accountability. The contract should specify the actual cost of in house day services. It should also make clear if residents are expected to pay for their lunch out and transport costs. ABC charts should be completed in all instances All activities the residents engage in should be fully recorded to evidence that they are doing purposeful activities. Staff should maintain full records of residents dietary intake. Residents should not pay for their own lunches whilst out for the day. Records of chiropody should be maintained. If residents are prescribed tranquillizers as required there should be written guidance for staff to indicate the circumstances in which it should be given. The job description of the staff member identified must be clear and identify the limitations of her role. All staff should be have formal supervision a minimum of six times per year. The work surface which is damaged should be replaced. Sycamore Lodge Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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 Care Home C53 C03 S26475 Sycamore Lodge V226459 130505 Stage 4.doc Version 1.30 Page 32 - 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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