Inspection on 21/08/07 for Sycamore Lodge Care Home

This inspection was carried out on 21st August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sycamore Lodge Care Home 15/08/06

Sycamore Lodge Care Home 10/03/06

Sycamore Lodge Care Home 29/11/05

Sycamore Lodge Care Home 19/01/05

Sycamore Lodge Care Home 15/06/04

Sycamore Lodge Care Home 21/05/03

Sycamore Lodge Care Home 17/06/02

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

CARE HOMES FOR OLDER PEOPLE Sycamore Lodge Care Home 2 Burringham Road Scunthorpe North Lincolnshire DN17 2BB Lead Inspector Mrs Jane Lyons Unannounced Inspection 21st August 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Lodge Care Home Address 2 Burringham Road Scunthorpe North Lincolnshire DN17 2BB 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) 01724 856963 F/P 01724 856963 sycamorelodgehome@hotmail.com Mr Sukhuinder Marjara Mrs Margaret Williams Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: Sycamore Lodge is situated in the Ashby area of Scunthorpe, it is close to the local amenities and on a number of bus routes. The home provides care including nursing for up to 40 service users over the age of 65. Accommodation is provided on two floors; there is stair and passenger lift access to the first floor. There are thirty single rooms and five shared rooms; en- suite facilities are provided in eight of the single rooms. The home has a good variety of day space; there are two lounges, a dining room and a conservatory. All rooms are decorated and furnished to a good standard. The home has a pleasant, homely inclusive atmosphere. The home is owned by Mr S Marjara. The registered manager is Mrs M Williams. Weekly fees are: £320- £500. The home does operate a system whereby the fees could include a third party contribution. Additional charges are made for the following: escort to hospital appointments, toiletries, newspapers/magazines, hairdressing and chiropody. Information on the service is made available to prospective and current service users via the statement of purpose, service user guide and inspection report. Documents are made available prior to and following admission, copies are available on request. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 1 day in August 2007. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 15th August 2006 including information gathered during a site visit to the home. • • • The visit to the home lasted from 9 a.m. until 6 p.m. Eight residents spent some time chatting to the inspectors. The inspector also talked to four care staff, one nurse, three visiting district nurses, a visiting care manager, six visitors, the manager, the administrator and the owner. Questionnaires about the home were sent to twenty of the people who use the service, twenty staff and fifteen relatives. Three relatives questionnaires, fourteen of the staff ones and fifteen from the people who use the service were returned at the time this report was written. The inspector also looked around the home and looked at lots of records including care plans, staff recruitment records and other records about the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. The inspectors observed how staff and service users worked together throughout the day. People’s views about the home and what was found during the visit have been used to write the report and make judgements about the quality of care. • • • • What the service does well: Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 6 The home provides good facilities; all areas were decorated and maintained to a good standard, very clean and tidy. There was a very relaxed and homely atmosphere in the home, people using the service were observed to be very settled and comfortable in their surroundings. The home makes sure that people are only admitted to the home after they have had an assessment of their needs. Staff members also obtain assessments done by the local authority, this helps them decide whether or not people’s needs can be met in the home. Prospective new residents and their relatives are always encouraged to come and visit the home before they are admitted. Two relatives commented on how welcoming and open the management and staff had been when they visited the home, they were particularly impressed that they did not have to make an appointment. People who use the service liked the food provided, are well fed and encouraged to eat a healthy diet. There were good visiting arrangements and visitors were made to feel very welcome, discussions with a number of relatives confirmed this. Proper recruitment checks were made before new staff start in the home to ensure they are safe to work there. The service is part of the local community and those living near by are invited to some social events held in the home as well as well as relatives and friends. The home works hard to improve the quality of its service by asking the opinions of the staff, residents and relatives. What has improved since the last inspection? The medication systems have been further improved by more accurate recording of all new medication received by the home, this ensures the records are up to date and protect the health and safety of the people using the service. The nursing and care staff have made significant improvements to the frequency by which they record in the care plans this will better ensure people who use the service are looked after properly. A number of rooms have been redecorated and refurbished, a new shower room has been provided and more work is planned for the future which means individuals live in pleasant, well maintained surroundings. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 and 6. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives are provided with sufficient information to help them decide if the home is right for them. The admission process is thorough with staff ensuring that new residents feel welcome and secure. EVIDENCE: The service user guide and statement of purpose documents had been updated to provide prospective new service users and their families with current information about the service. The administrator confirmed that the documents Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 10 could be translated into different languages; advice was given to provide the documents in large print. Each person has their own individual file; the inspector case tracked four of the care files which demonstrated that the format of the homes needs assessment covers all required areas; copies of completed assessments were detailed and appropriate. Copies of the Local Authority assessment and care plans were obtained prior to admission for those residents referred through the local Social Services care management teams. In addition to the pre admission assessment the home undertakes a further assessment of strengths and needs once the person has arrived. It is on the basis of both these assessments that the person’s plan of care is formalised. A number of surveys returned from people who use the service had identified that they had not received contracts however all files examined held a signed copy of the written contract/ statement of terms and conditions. Copies of the letter written to potential service users following the manager’s assessment visits to confirm that the home can meet their needs were also held on file. People who use the service spoken to during the visit told the inspector that they had chosen the home for reasons such as: the friendly atmosphere, the facilities/ location and the openness of the management. A survey received from relatives detailed that they had completed research such as reading inspection reports, visited other homes and chosen Sycamore on the basis of this. Relatives of a person who had recently moved to Sycamore Lodge told the inspector that the staff had made them all very welcome and their relative had settled into the home very well. Staff spoken to confirmed that they were always informed of new residents care needs. Visiting relatives were happy with the care being provided. There was evidence to demonstrate that care staff had accessed some service specific training courses however advice was given to provide more staff with a wider range of courses which will help ensure that they have the skills to enable them to deliver up to date care methods and have a better understanding of the varied conditions common to the elderly. The home does not provide intermediate care support. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people who use the service are well met in a way that respects their privacy and dignity. The medication systems at the home are well managed ensuring the promotion of good health. EVIDENCE: Case tracking of four care files was completed, which included examination of care records and discussions with people who use the service and staff. The home continues to produce and keep clear and well-written care plans for individuals which take into account their choices and decisions; the four Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 12 examined set out the health, personal and social care needs identified for each person. A person with specific needs associated with their ethnicity had recently been admitted to the home; the care plan clearly described the individual care to support the cultural, communication, personal care, dietary, social and religious needs. A key worker who can speak the same language had been allocated and the inspector also observed specific communication support provided by the management during the visit. Although there was good evidence that the care plans had been updated when changes in need had occurred one of the plans examined would now benefit from complete review to ensure all aspects of the plan had been updated to clearly identify the current care support. Risk assessments were in place for tissue viability, moving/ handling, nutrition, and falls; these had been reviewed regularly and all high-risk areas had associated care programmes in place. All care plans had been signed by the person or their family. Information about the person’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are all included within the individuals care plan. Key worker records had been maintained and improvements in the completion of daily records had been made although there were still a small number of omissions. All care plans had been evaluated monthly and there was evidence that review meetings were held. The inspector spoke to a care manager following a review meeting held during the visit; she reported that gaps in the care plan identified at the previous review meeting had been fully addressed; the care plan clearly detailed all the individuals specific care needs and there was good evidence that the home was meeting these needs well and the individual had settled well in the home. The persons relatives also told the inspector how satisfied they were with standards of care provided. There was good evidence that the home sought support from the health care professionals such as Community Psychiatric Nurses, dieticians and District nurses when necessary. During the inspection the inspector spoke to three of the District Nurses who regularly visit the home; they confirmed that the communication with the home was good, staff were always very helpful and they considered the staff demonstrated a very caring and supportive attitude towards individuals. Continence care is promoted and the inspector observed documentation recording the continence products supplied to the individual. Any concerns regarding pressure care are recorded and risk assessments clearly detail the type of pressure relieving equipment provided. Comments returned from people who use the service and relatives show overall that they are generally very satisfied with the care and support offered by the staff; one survey identified difficulties in accessing a visit from the Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 13 General Practioner which was passed on to the manager however all other surveys confirmed appropriate access to medical support. Chats with the people using the service revealed that they were happy with the way in which personal care is given at the home, and they felt that the staff respected their wishes and choices regarding privacy and dignity. There were a number of comments on the surveys about care staff being very busy and having to wait for support at times; observation during the visit evidenced that the staff were on the go throughout the morning shift, they were organised and worked efficiently to try and meet the needs of the individuals. Three individuals spoken to said how lovely and kind all the staff were. Two people wrote that they were very happy and content, one relative wrote that they were very happy with the care their loved one received and they found the staff very approachable. The inspector observed that individuals were treated sensitively by staff regarding assistance with personal care, and that their right to privacy was respected. Medication systems were examined; policies and procedures were in place which covered all areas of management however some of them are limited and now need to be reviewed and developed to provide more detailed and up to date instructions and methodology for all aspects of the system. There was evidence that the staff are proactive in ensuring that service user’s medication is reviewed by the G.P. Temperature recordings of the medication storage room and refrigerator are taken daily which were satisfactory. There was evidence that people who use the service are supported to self – administer their medications; risk assessments were used to support the practise. All of the individuals chosen for case tracking prefer to have staff administer their medication. Storage of all medications was found to be satisfactory. Transcribing and medication administration records were completed satisfactorily. Records of receipt and returns of medication were in place and up to date; a recommendation to improve the recording of medication entered on the medication administration sheets had been actioned with effect. The nursing staff currently administer all the medications in the home. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with choice and diversity in the meals and activities provided by the home although there are some gaps in the level of one –to one support provided for the more dependent persons. Relatives and visitors are made welcome at the home and good links to the community enrich the peoples social and leisure opportunities. EVIDENCE: Observation during the visit indicated that the home supports people who use the service to make decisions within their capabilities and operates flexible routines, these include the time people who use the service get up, go to bed, where they eat their meals and how they spend their time. One individual told the inspector how they had had a lie in that morning which they liked to do every now and then. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 15 Friends and relatives are welcomed into the home and evidence in the case records confirmed staff kept them appropriately informed of important issues concerning the needs of people living in the home and also that people who use the service were supported to keep in touch with friends and family; recent key worker notes for one entry detailed support with letter writing to a friend. The inspector observed a large number of visitors to the home throughout the day, all friends and relatives spoken to said that the staff were very welcoming and supported their visits. Information gathered from the surveys and discussions with residents indicated that the majority of people were very satisfied with the activity programme and social events provided at the home. Comments from two people included “there aren’t enough activities for the over 90’s” and “I would like more attention and activity, sitting all day is very boring and soul destroying”. All the residents spoken to said how much they liked the activity co-ordinator, who is employed for two days per week; she arranges a varied programme of activities, entertainments and trips out. Recent visits to garden centres, Normanby Hall, Cleethorpes had been enjoyed by all who had taken part however a number of recent trips have had to be cancelled due to problems with the transport provider; the owner of the home confirmed that he had recently secured funding for a minibus to be used by Sycamore Lodge and the two sister homes, which would support residents to access more regular trips out. A number of people who use the service are regularly supported to visit the local market and shops, The annual summer fete had been held the previous weekend, all persons spoken to said that they had enjoyed themselves; the manager confirmed that many local residents had also participated. Eight of the fifteen staff surveys indicated that they felt they did not have enough time to spend with residents. There are records of social activity in the care files however these are not maintained consistently; the activity co-ordinator also maintains separate records to support participation and satisfaction with the programme. Advice was given to look at providing more in depth social plans of care which would identify those individuals who need more gentle stimulation and one-to one support and to maintain a central record of support provided. Information from the residents’ files indicated that there are a number of individuals who follow different spiritual faiths, including Catholic and Church of England. The staff confirmed that there are regular church services (monthly) within the home and the Catholic priest visits weekly to give communion to those who want to partake. Details about advocacy services are made available for individuals; they are displayed in the home. The frequency of residents meetings has tailed off; the manager told the inspector that the majority of persons were not interested in attending the Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 16 meetings, advice was given to continue to hold regular meetings and encourage persons to attend and contribute their opinions on how to improve the service. Comments from the surveys received from staff, relatives and people who use the service indicate that overall there is a good level of satisfaction with the meals provided by the home. One individual said “ the meals here are lovely” and another commented “ the cook is really good, she comes round everyday so I can tell her what I would like”. Observation of the midday meal showed it to appetising and well presented, the kitchen staff had made an effort to provide soft/ pureed diets in an attractive way. The majority of residents use the dining room and the mealtime was seen to be a relaxed and social occasion with the staff interacting well; individual support was provided patiently and discreetly. Menus are available on the dining tables and a chalkboard on the wall gives information about the choices on offer each day; the home rotates between a summer menu and winter one; the cook was unable to confirm when the menu had last been reviewed which should now take place. The kitchen assistant or cook visits all individuals daily to discuss menu choices; the staff demonstrated a good knowledge of the individual residents’ nutritional needs and preferences. A number of specialist diets were being provided and many individuals were receiving “fortified” diets; resident’s weights are monitored regularly and any concerns are referred to community health services for support. The kitchen areas appeared clean, tidy and well managed; recommendations made at the last Environmental Health Officer visit had been actioned. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had a satisfactory complaints system with some evidence that people who use the service feel that their views are listened to and acted upon. Procedures are in place and training provided to staff to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: Checks of the complaints record shows that the home has not had any formal complaints since the last inspection. Discussion with the manager indicated she would deal with any ‘niggles or grumbles’ on a daily basis; she had introduced a “niggles book” and a complaints/ concerns/ comments box which has yet to be used. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. People spoken to showed a clear understanding about how to make their views and opinions heard and said ‘I would speak to the nursing staff or the manager if I had any issues”. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 18 A procedure for responding to allegations of abuse was available and training records showed all staff had recently been provided with training in safeguarding adults from the local authority. When asked about abuse, what it was and what they would do if they saw a person who uses the service being abused, the staff answered correctly. Staff interviewed also had a good knowledge of whistle blowing procedures. Recruitment practises remain robust; staff records evidenced that new staff had not commenced work prior to satisfactory police checks and references being in place. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good, providing individuals with an attractive and homely place to live. EVIDENCE: The home provides and maintains very comfortable and safe facilities. All areas of the home are decorated and furbished to a very good standard. There is a maintenance programme in place; redecoration and refurbishment is carried out where needed; the previous years programme had focussed on upgrading the communal areas which has been carried out with good effect, this years Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 20 programme includes further bedrooms and bathroom/ toilet facilities. A new shower room has been provided on the ground floor which staff and people who use the service commented was a big improvement. The registered provider has had plans approved for an extension to the property, which will provide the home with more single room accommodation with en- suite facilities. The laundry room was tidy and organised; new washing machines have been provided, the administrator told the inspector that the home has been using new detergent products that are more effective and have resulted in positive comments from residents and their families. One relative wrote on the survey that the staff look after her loved ones belongings very well, her clothes are always clean and stain free. Some staff have had training on infection control but this is not recent; it would be beneficial for staff to undertake or update this training. On the day of the site visit, the home was clean and free from offensive odours; domestic staff are employed for seven days per week. Two relatives told the inspector that the home always smells nice and fresh. The communal areas were all well utilised during the visit; people who use the service commented on how happy and settled they were at the home. Bedrooms had been personalised to varying degrees and individuals confirmed they were able to bring in small items to decorate their room. Residents and relative surveys indicated that they were very happy with the home in general and the bedrooms, comments included: “the staff keep the home nice and clean”. Fifty percent of the staff surveys returned identified that they didn’t consider the home had enough equipment, all these surveys identified that another electric hoist was needed but a number also identified the need for more commode chairs. The manager confirmed at the visit that the home had recently purchased a new electric hoist which staff reported had assisted greatly with their daily routines by cutting down the time they and the residents had to wait for equipment to be available. The manager confirmed that she would further discuss the need for more commode chairs with the staff. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are cared for by a group of staff who demonstrate a very caring manner and provide a very good standard of care but a number of individuals felt at times that they had to wait too long for assistance and staff have at times felt over stretched. Staff have accessed various training opportunities and some have achieved NVQ Level 2 or 3 in Care but some core training undertaken by staff is ‘out of date’ and this could result in poor practice. Recruitment practices afford sufficient protection for people who use the service. EVIDENCE: The home was fully occupied at the time of the visit providing care for thirty eight people; nineteen of these had identified nursing needs. The manager confirmed that the dependency levels in the home remained high even though the ratio of people receiving nursing care support had decreased in recent times. The home completes detailed dependency assessments on all the people who use the service each month, currently these statistics are not used to Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 22 inform management of the overall dependency levels which would be useful in supporting the numbers of staff rostered each shift. From examination of the staff rotas, levels of six care staff in the a.m. and five care staff in the p.m. were being maintained. There is a qualified nurse on each shift and on most morning shifts the manager tries to roster two nursing staff. At the previous inspection visit the home was providing a second nurse on the afternoon shift which has not been continued. Comments from the surveys and discussion with the staff indicated that there continues to be some concerns about the levels of staff on duty; the previous inspection visit identified concerns in this area and a recommendation was made to look at skill mix issues and review staffing arrangements/ supernumerary time for new starters which has not been fully actioned. Discussions with the care staff during the visit identified that the morning shift continues to be very busy and they had at regular times felt overstretched in trying to meet all the residents’ needs. Staff said they feel rushed and ongoing problems of staff sickness, holiday cover and new starter arrangements are creating unfair pressures on their workloads. One staff member said they felt frustrated that they couldn’t provide the quality of care the residents deserved. Of the fourteen staff surveys returned: 7 detailed that they felt there weren’t enough staff, and 7 felt there were enough staff. Eight staff also detailed that they felt they did not have enough time to spend with service users and six staff considered they had enough time. Surveys completed by relatives and people who use the service indicated that the majority of people considered that there was “always” or “usually” enough staff available at the home; however a number of comments detailed that the home would benefit from more staff and people at times have to wait for care support. There has been moderate to high staff turnover within the last twelve months with nine members of care staff having left. The home currently provides new care staff with one supernumerary shift and then the staff member is counted as one of the staff complement; staff commented that they considered this unfair and new care staff should have more supernumerary time to ensure they gained competence in the delivery of care. As at the previous inspection the above comments were shared with the provider and manager, and it was recommended that they audit the staff opinions around the cover for sickness/ holidays and new starter arrangements, to help them review the existing management strategies and make any changes as needed. The utilisation of accurate dependency monitoring statistics is now a vital contribution to ensuring appropriate levels of staff are rostered to meet the individual needs of the people using the service. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 23 The home had a training plan and there was evidence that mandatory, general and service specific training was covered. Records evidenced that staff were up to date with mandatory courses in fire safety and moving/ handling. General and service specific courses such as safeguarding adults, palliative care, continence and BM stick testing have been provided in the last twelve months however due to the staff turnover a significant number of staff have not accessed training in areas such as infection control, tissue viability and conditions common to the elderly. Training records also evidence that some of the general training courses undertaken by staff is now ‘out of date’ and the inspector recommends that on-going updates should be arranged to ensure that the skills and knowledge held by staff are current. A number of staff were scheduled to attend courses in equality/ diversity and health/ safety in the near future. Staff training records evidenced that the home provides new staff with the skills for care induction training programme. Information provided prior to the visit evidenced that the home has now dipped under the target figure of having 50 of care staff trained at NVQ level 2 and this has been due to staff turnover; currently the home has 12 out of 27(44 ). However four new members of staff have recently enrolled on the course. Employment records for five staff appointed since the last inspection were examined. This showed that all workers had Protection of Vulnerable Adult register checks (Pova 1st) or Criminal Records Bureau check (CRB police check) in place prior to commencing employment and that they all contained the relevant documentation to comply with Schedule 2 of the Care Home Regulations. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of self-review and consultations, which includes seeking the views of residents, staff and relatives. The lack of regular checks on the bed rails is potentially putting people who use the service’s safety at risk. EVIDENCE: Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 25 The registered manager of the home has been employed in the home for eight years; she was appointed manager and completed registration with the Commission in 2003. The manager has completed her Registered Managers Award and updates her skills and knowledge through regular attendance at training sessions. Comments from staff indicate that they consider the management of the home is very organised and that the manager is approachable and supportive. Certificates on the wall of the home and discussion with the Provider and Manager indicate that the North Lincolnshire Council has awarded the home its Gold Standard for Quality Assurance, this award was achieved in 2002 and has been reaffirmed by the council since this time. The home is also accredited with Investor in People Status since 2002 and this too has been reaffirmed. The home has maintained an internal quality assurance programme; feedback is sought from the residents and relatives through regular surveys and staff complete regular audits on key areas of service in the home. Results of the surveys and audits have been analysed and where deficiencies have been identified, action plans have been drawn up. The results of the audits and surveys have been published in graph form on a notice board for residents and visitors to see. Advice was given to formally revisit the action plans to clearly identify how improvements will be made with associated time-scales. The home has produced an annual development plan which identifies the quality areas of improvement from 2006 and clearly sets out the standards to be achieved in this year. Although the policies and procedures are reviewed annually, a number of the documents were found to be limited in the depth of information they gave and advice was given to review them ensuring that they clearly reflected current practices in the home and that they were updated to meet current legislation and good practice. Checks of the financial records showed that residents are able to have Personal Allowance accounts in the home. These records are hand written and each person has their own account sheet, which is updated each week by the manager/administrator. Information from the manager indicates that the residents have a family member or representative who looks after their monies and these individuals make sure the Personal Allowances are sent/brought into the home. Each resident has their own wallet for their money and receipts of all transactions undertaken are kept in their file. Checks of these showed them to be accurate and up to date. The home does not keep large amounts of cash on the premises and if a person’s allowance builds up it is returned to the family/representative for ‘safe-keeping’. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 26 Checks on staff supervision records showed that the programme had been well maintained; all staff access regular sessions and the care staff had accessed the required amount of sessions (six) within twelve months. The supervision sessions with the staff are structured and cover all aspects of practice, philosophy of care in the home and any career or training/development needs of the individual. Staff had also accessed an appraisal session; advice was given to ensure the individual training needs identified were more clearly linked to the home’s training programme. The provider is carrying out monthly regulation 26 visits to the home and provides the Commission with copies of the reports generated from these visits. Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment, checks and risk assessment were all in place and up to date. The maintenance man completes regular checks of the hot water temperatures. Accident records were completed and in place; these are audited by the manager to review action taken to reduce reoccurrence. Records evidenced that the home was utilising a very large number of bed rails, over 80 of people who use the service had bed rails in place. Records showed that staff completed a risk assessment to support this provision, however the risk assessment did not cover the areas identified by The Medical Devices Agency such as: type of rail used, height of bed, height of mattress etc. All bed rails were checked in the home annually which does not meet current guidance issued from the MDA; systems in the home need to be reviewed to ensure these rails are checked on a much more frequent basis and more detailed risk assessments are in place. The management also need to review the amount of rails used in the home to ensure only those individuals who meet the criteria for use are provided with this type of equipment and to remove rails from beds where they are not needed. Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 2 Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18(1) a Requirement The registered person must ensure that systems are in place to demonstrate that appropriate numbers of care staff are employed and rostered to meet the dependency needs of the service users. The supernumerary time for new starters must be reviewed to ensure that they are adequately supported and an appropriate skill mix of staff on each shift can be maintained. Timescale for action 30/10/07 Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP12 Good Practice Recommendations Produce information about the service such as the statement of purpose and service user guide in large print. Review the system for providing social/ sensory stimulation and support for the more dependent individuals to ensure adequacy. Consideration should be given to centralising the records of social provision to provide more detailed and regular recording. Review the homes menus to ensure they meet with the current dietary needs and preferences of the persons using the service. Ensure that the 50 of the care staff have achieved NVQ level 2. Ensure that staff receive continuous training updates to ensure that their practice is ‘up to date’. Ensure that action plans produced from results of audits and surveys have clear areas for improvement identified with timescales and these areas are revisited to support continuous improvements within the service. Ensure that the staff’s individual training needs identified through the appraisal programme are formally linked into the staff’s training and development programme. Review all the homes key policies and procedures to ensure they are comprehensive, comply with current legislation and demonstrate current good practice. Guidance issued by the Medical Devices Agency with regard to the safe use of bed rails should be fully implemented. Risk assessment documentation should be more detailed and safety checks on bed rail equipment should be carried out more frequently. The overall number of bedrails in use in the home should be reviewed. 3. 4. 5. 6. OP15 OP28 OP30 OP33 7. 8. OP36 OP37 9. OP38 Sycamore Lodge Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Care Home DS0000002807.V349103.R01.S.doc Version 5.2 Page 31 - 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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