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Inspection on 27/09/05 for Sycamore Lodge Care Home

Also see our care home review for Sycamore Lodge Care Home for more information

This inspection was carried out on 27th September 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents do lots of activities in the community and get the chance to go out for lunch, to college and day services. The food provided is home cooked and healthy. The residents` health care needs are properly assessed and treatment is provided by a range of health service professionals. The home is clean throughout.

What has improved since the last inspection?

The arrangements for medication have improved and there is evidence that these are given as prescribed. There are written instructions about administering tranquillizers when they are prescribed "as required" and the application of sunblock to prevent sunburn is now recorded. The kitchen is clean, bright and many improvements have been made since the last inspection. There are details of healthy diets on the kitchen wall, fresh fruit and vegetables were seen and the cook was well organised with a clear understanding of safe food handling practice. Different drinks were offered and provided with the lunchtime meal and the residents seemed to be enjoying their food. There have been significant improvements to the environment since the last inspection. Many rooms have been redecorated and look fresher, new flooring and carpets have been fitted in several rooms, although a couple still need to be fitted. As a result of these changes the home provides a much more comfortable and homely environment for the residents. The care planning system is being overhauled and this will be an improvement if fully used once completed for all residents. Staff have had training on various topics and show greater levels of awareness about abuse, whilstleblowing and their reporting responsibilities. The arrangements for residents` finances are now much better and allow checks to be done more easily.

What the care home could do better:

There is evidence that some members of staff are still not treating the residents with dignity and respect and a further allegation of abuse was made on the day of this visit. The care plans are still not detailed enough to guide staff properly in how to meet the needs of the people living at the home. There is still no indication that there is proper monitoring to make sure that staff follow care plans nor of formal supervision of the staff to check their performance is acceptable. Many of the residents are very vulnerable, because of their needs and the fact that they may not be able or confident in expressing their views or needs but no one has an independent advocate to help with this. One resident said he doesn`t like living at the home and wants a review. The checks on staff are not good enough to make sure the residents are properly protected from harm and abuse. The record keeping at the home is not good enough and does not meet legal requirements or enable proper evaluation of the service. There is no evidence that the registered person is proving that she is fit to be registered by doing regular checks on the conduct of the home. She needs to show that she is checking that records are up to date and the home is being run in the best interests of the residents to continue her registration.

CARE HOME ADULTS 18-65 Sycamore Lodge Care Home 3-5 Hardy Street Nottingham NG7 4BB Lead Inspector Linda Hirst Unannounced Inspection 27th September 2005 10:25 Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 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 DS0000026475.V253922.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sycamore Lodge Care Home Address 3-5 Hardy Street Nottingham NG7 4BB 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) 0115 9784299 NO FAX Mrs Aisha Khan Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20/6/05 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 DS0000026475.V253922.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. The staff records, training, quality assurance and finances were all inspected to check that they are up to date and properly recorded. 5 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? The arrangements for medication have improved and there is evidence that these are given as prescribed. There are written instructions about administering tranquillizers when they are prescribed “as required” and the application of sunblock to prevent sunburn is now recorded. The kitchen is clean, bright and many improvements have been made since the last inspection. There are details of healthy diets on the kitchen wall, fresh fruit and vegetables were seen and the cook was well organised with a clear understanding of safe food handling practice. Different drinks were offered and provided with the lunchtime meal and the residents seemed to be enjoying their food. There have been significant improvements to the environment since the last inspection. Many rooms have been redecorated and look fresher, new flooring Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 6 and carpets have been fitted in several rooms, although a couple still need to be fitted. As a result of these changes the home provides a much more comfortable and homely environment for the residents. The care planning system is being overhauled and this will be an improvement if fully used once completed for all residents. Staff have had training on various topics and show greater levels of awareness about abuse, whilstleblowing and their reporting responsibilities. The arrangements for residents’ finances are now much better and allow checks to be done more easily. 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 DS0000026475.V253922.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 6, 7 The new proposed care planning system is an improvement but only if the staff are monitored to make sure that they are following them properly. As it stands, the care plans seen are not detailed enough to properly guide staff in meeting residents’ needs. EVIDENCE: A new system of care planning is being introduced and the staff are being asked to sign to confirm that they have read and will abide by the care plans as stipulated. This is an improvement on the previous system, but as can be seen from the comments made in YA3 these are still not being translated into practice and there must be evidence not only that the staff have read the plans but that they are following them. In addition in order to prove fitness to be registered the responsible individual must ensure that there is evidence that inadequate practice is challenged and action taken to address any shortfall. Care plans are still not being reviewed at the recommended intervals and still have omissions, in some cases of key monitoring information. There is no evidence of residents, their representatives or advocates being involved in the development and reviews of their care plans, nor of any valid, recorded reasons for this omission. This matter must be addressed. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 10 None of the residents have the input of an independent advocate, despite the fact that many have few or no visitors, have no verbal communication and extensive physical and learning needs. Referrals should be made for all residents in this situation to support them in ensuring their needs are properly met. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 12, 14, 16, 17 Community based activities are provided regularly for residents, but the interactions in the home were less positive and more about staff preventing residents doing things than engaging in a meaningful way with them. Some staff respect the privacy of residents and understand their rights and issues of personal dignity, others do not demonstrate an appreciation of this philosophy in practice. No one at the home has the active involvement of an independent advocate, and there is a clear need for this. The kitchen is clean, well organised and managed. The food provided is healthy and the meals well balanced to ensure the residents’ health is promoted and maintained. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 12 EVIDENCE: One of the residents who was interviewed attends college and day services five days a week. Others were seen going out to the shops, for walks and out for lunch during the course of the inspection. One of the residents was interacting with an inspector and responded very positively, however, no staff were seen actively interacting with this resident during this visit. In many cases the interventions of staff were seen as being more about preventing them doing things than positive, valued one to one interactions. During the course of the day a resident was observed taking a call from a relative on a cordless phone, the staff showed respect for his privacy and did not intrude. One of the care staff interviewed demonstrated a good level of awareness of the residents’ rights and issues of respect, but as can be seen from previous comments, not all staff follow these principles in practice. There were a number of issues raised at the last inspection in respect of the kitchen. These have been addressed and the new cook has made significant improvements in the kitchen. The kitchen was clean, newly decorated and several items of new equipment have been provided. There were lists on the walls of healthy eating options, and evidence of fresh fruit and vegetables in the home. Lunch was observed and comprised shepard’s pie with mixed vegetables followed by fruit crumble. Several drink options were available to accompany the meal and these were seen being served. Several residents need assistance to eat and staff members were seen sitting beside residents helping in a sensitive manner. A full record of residents’ dietary intake is still not being maintained. Given that many of the residents cannot make informed choices about food these records serve to evidence that the food provided to individuals is healthy, balanced and adequate in terms of quantity. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 19, The residents’ health needs are properly assessed and provided for by a range of health care professionals. EVIDENCE: Nursing care is provided at the home, but in addition one person has physiotherapy, another hydrotherapy. The dietician is involved with one resident as a result of long standing problems with food and fluid intake. Two residents have pressure relieving mattresses on their beds as a preventative measure. Many of the residents have input from the Psychiatrist and some residents also have input from the Clinical Psychologist. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 22, 23 It is impossible to evidence how complaints are received and investigated as the records could not be found. Although staff have a greater understanding of what constitutes abuse, not all staff respond in an appropriate way under challenging circumstances and another allegation has been received during this inspection. The number and nature of the allegations being made indicate clearly a failure to properly protect residents from potential harm and abuse. EVIDENCE: The complaints record could not be found, and all papers relating to complaints must be kept together at the home and be available for inspection. An immediate requirement was set in relation to this matter as it is an outstanding requirement from the previous visit. The two allegations of abuse, made just prior to the last inspection are still unresolved legally. The Police are investigating both, although the registered person has conducted their own investigation into one of the incidents. These papers were inspected and were found to be acceptable and appropriate action had been taken. The residents’ monies are no longer pooled but held individually and those inspected tallied with the amounts recorded. Residents are now billed only for the items they are personally responsible for. However, there are no receipts for some purchases from shops and there is no reasonable explanation for this omission, wherever possible there must be evidence of the money residents have spent. There is an outstanding requirement for the bank statements for the residents who share an account to individually detail the credits and withdrawals for each person. As some of these residents have a significant Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 15 amount of money accrued an account which earns each interest on their money is strongly recommended. During the course of this inspection a resident said that staff shout at him which is concerning in light of the recent allegations of abuse at the home. This matter was referred to the manager to investigate and will be notified under Adult Protection Procedures. There is evidence that staff have received further training on abuse, restraint and challenging behaviour provided in house by the Manager and the Deputy and this was confirmed by the staff interviewed. The Manager was said to be a qualified trainer in respect of supporting people with challenging behaviour but her staff file could not be found and therefore there is no evidence that this is the case. This evidence must be forwarded to the Commission for Social Care Inspection to ensure that this essential training has been supplied by a suitably qualified trainer. Until this is received, the requirement will remain outstanding. All bruising is now properly recorded and dated and the staff interviewed demonstrated awareness of what constitutes abuse and of the whistleblowing policy. However, as can be seen from the comments above and as detailed in YA3 this awareness is not necessarily reflected in their practice. If these issues continue to be apparent, as they have for the past three inspections further action will be taken as there is clear evidence that the registered person is failing in their duty of care towards the vulnerable residents at the home. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 24, 30 There have been significant improvements in the physical standards of the home, the outstanding matters must be addressed to make sure that the residents live in a safe and comfortable home. EVIDENCE: A tour of the accommodation was undertaken to check whether previous requirements had been met. There have been several significant improvements since the last inspection and the accommodation is looking fresher, cleaner and more homely. The activity “hut” has been improved significantly and is now safe, decorated and suitable for use, although the staff stated that it is used as a staff room at the moment. In spite of these improvements, there are outstanding matters which need to be addressed. • The television is still not working properly and this must be replaced. • The carpet in the small lounge is still awaiting replacement, although there are plans to do this the requirement will remain until these two matters have been completed. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 17 • • The deputy manager said that the carpet in the main lounge had been cleaned, but on the day of the inspection it was dirty and stained. It must be kept clean or replaced. The broken light above the sink in the first floor toilet has yet to be replaced and presents a risk to residents as it has sharp edges. An immediate requirement was left to remove or repair the light. The domestic staff on duty were interviewed during this visit to check that they are working within their job description, and they confirmed they only undertake domestic duties and work to a cleaning rota which was given to the inspectors. The areas of the home seen during the tour were clean and hygienic, the kitchen especially had improved significantly. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 36 The staff have not had the specialist training they need in working with people with learning disabilities, and one person who has does not use this knowledge in practice. The staff do not treat the residents with respect, nor value their personal dignity and abusive practice results from this which is not being properly addressed. The recruitment practices of the home remain inadequate and the systems to protect residents are not robust enough and place the residents at risk of harm and abuse. The failure to properly assess the attitudes and supervise the performance of staff places residents at continued risk of abuse. EVIDENCE: All of the staff on duty (including ancilliary staff) were interviewed as part of this inspection to identify what training and guidance they have had in relation to their role and responsibilities. Only one of those interviewed confirmed she had undertaken Learning Disability Award Framework training, and this has now been an outstanding requirement for the past three inspections. The situation will not be allowed to continue. All staff must have this training within the timescale identified on this report or enforcement action will be considered. During the course of this inspection staff interactions with the residents were observed and overheard and the attitude of one qualified member of staff was Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 19 found to be very concerning. The member of staff was asking a resident to go to the toilet in a very loud voice over and over again, this came across as commands rather than encouragement. The staff member then said to the inspector that the resident “stinks” as there were clearly continence issues. At lunchtime the same member of staff was heard saying “dinner, dinner,” without directly addressing the residents. Throughout the interactions seen this staff member never addressed any of the residents by name. Please also see the comments made under YA23 about staff “shouting” at residents. Two residents were seen without footwear, but there were no recorded reasons for this in the care plans. There has been an outstanding requirement for the last three inspections for the registered person to ensure that the staff treat all residents with dignity and respect and for lists to be maintained of the staff who have received these instructions. The member of staff involved in the incident described above confirmed that this training has been received. If this is the case the evidence suggests it is not being put into practice. These concerns were raised with the Deputy Manager for investigation and action. A copy of the investigation must be forwarded to the Commission for Social Care Inspection without delay. This ongoing situation is completely unacceptable, and concerning in light of the allegations made in the past year and indicates a continued lack of oversight and monitoring of the performance of staff. The failure to support and protect residents adequately is indicative of a lack of fitness and if these matters are not properly addressed enforcement action will be unavoidable. Staff files were inspected to check that all of the correct documents were in place to properly protect residents from abuse. These did not contain some of the necessary documents to prove identity. The manager’s file could not be found and it is required that this is kept on the premises and available for inspection. There were missing copies of work permits and visas for oversees staff and one member of staff had started work without a Criminal Records Bureau (CRB) check or evidence of a Protection of Vulnerable Adults First (POVA First) check. In addition there are three members of staff who still do not have a returned CRB check and who are working unsupervised with the residents. Until there is evidence of a POVA First check on file these members of staff must be fully supervised. An immediate requirement has been set in respect of this issue. These practices place the residents at risk of harm and abuse and call into question the fitness of the registered person. Unless practice improves significantly in this area enforcement action will be considered. There is a supervision policy in place but this has not yet been started. There is an outstanding requirement for staff to be appropriately supervised at all times and a recommendation that this should be a formal meeting held six times a year, evaluating performance. There are still some concerns about the lack of formal checks on staff and about their attitudes and performance and by failing to provide evidence of proper supervision the registered person is unable to evidence that the home is being run in a way which protects residents from abuse and supports their best interests. See comments under YA 39 and 43. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41, 43 The registered person cannot evidence that the home is being conducted in an appropriate manner and in the best interests of residents. This calls into question their fitness to remain registered. EVIDENCE: The last audit of the service was undertaken last year, and resident questionnaires were not completed with the input of independent advocates. There has been no auditing so far this year, and in the absence of this the registered person is unable to evidence that the home is being run in an appropriate way and providing a good quality service to those who live there. Advice on quality assurance audits was given to the Deputy Manager. Given the fact that so many of the residents do not use verbal speech to communicate, have few visitors and have additional physical needs and disabilities the manager should provide evidence that they have been referred to a local independent advocacy service to help represent their needs and wishes. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 21 As can be seen from the comments under YA6, YA22, YA23, YA34, YA 36, YA39 and YA43 a number of the records required by Law to ensure the protection of the residents are not up to date and accurate. The Commission for Social Care Inspection has not received any notifications of significant incidents as specified in Regulation 37 and required by Law, although there have been several such reportable incidents. This matter must be remedied without delay to enable proper assessment of the service. A requirement was set at the last inspection for the registered person to demonstrate continued fitness to be registered. There have been several improvements to the physical standards in the building, staff have been provided with training and a new manager has been appointed, although no application to register has yet been received by the Commission for Social Care Inspection and an immediate requirement has been set in respect of this as an application was delivered by hand during this inspection. That said, there remains a requirement for the registered person to evidence that she is taking personal responsibility for inspecting and reporting on the conduct of the home. There is no evidence of an audit of the service so far this year, there is no evidence of the registered person undertaking monthly visits and producing reports on the conduct of the home as required by Law. In addition concerns about staff performance are still being identified and yet there is an absence of formal supervision and assessment of performance. The Commission for Social Care Inspection has not received any notifications of significant incidents as required by Regulation 37 and care planning still needs to improve to meet requirements and evidence that residents’ needs are being properly met. In order to remain registered and prove continued fitness these matters must be addressed without delay otherwise legal advice will be sought and acted upon. Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 22 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 X X X X X Standard No 22 23 Score 1 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 2 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X X X 3 X 3 LIFESTYLES Standard No Score 11 X 12 2 13 X 14 3 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 1 X 1 X 1 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sycamore Lodge Care Home Score X 3 X X Standard No 37 38 39 40 41 42 43 Score X X 1 X 1 X 1 DS0000026475.V253922.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Timescale for action 11/10/05 2 YA6 15 3 4 YA17 YA22 17(2), Sched 4 22 Care plans must be up to date, reviewed regularly and accurately reflect the needs of the 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. (This has now been outstanding for three inspections and must be addressed if enforcement action is to be avoided. Timescales of 15/3/05 and 20/6/05 not met). Immediate There must be evidence of 24/10/05 residents/their representatives/advocates being involved in the development and review of their care plan unless there are valid, recorded reasons for this not to occur. A full record of residents’ dietary 24/10/05 intake must be maintained. The registered person must 04/10/05 ensure that details of the complaints received by the home, their investigation and action taken are maintained in a complaints file and available for inspection. Timescale of 1/8/05 not met. Immediate DS0000026475.V253922.R01.S.doc Version 5.0 Sycamore Lodge Care Home Page 24 5 YA22 12, 4 6 YA23 13 7 YA23 13, 18 8 YA23 20 9 10 YA23 YA24 20 23 The attitude and performance of the identified member of staff must be investigated and a copy of the findings and any action taken sent to the Commission for Social Care Inspection. Immediate The allegations made by the resident identified must be notified and investigated under Adult Protection Procedures. A copy of these documents must be sent to Commission for Social Care Inspection. Immediate. All staff must receive formal training on supporting people with challenging behaviour. Timescale of 20/9/05 not met. The bank statements for the residents who share an account must INDIVIDUALLY detail the credits, withdrawals and interest payments for each person. Timescale of 1/8/05 not met. All purchases made on behalf of residents must be supported by a receipt. The following items must be repaired or replaced to ensure the premises are kept in a good state of repair and equipment is maintained in good working order. • The television • The carpet in the small lounge Timescale of 20/9/05 not met. Remove or replace the broken light over the sink in the first floor toilet. Timescale of 20/9/05 not met. Immediate The carpet in the main lounge must be kept clean or replaced. 04/10/05 04/10/05 27/11/05 24/10/05 24/10/05 24/10/05 11 YA24 23 04/10/05 12 YA24 23 11/10/05 Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 25 13 YA32 12 14 YA32 12, 4 The registered provider must arrange for all staff to have Learning Disability Award Framework training in relation to their work with the residents. (This has now been outstanding for three inspections and must be addressed if enforcement action is to be avoided. Timescales of 18/2/05 and 20/9/05 not met). The registered provider must ensure that all staff treat residents with respect. There must be written confirmation of the instructions given to named staff. (This has now been outstanding for three inspections and must be addressed if enforcement action is to be avoided. Timescales of 25/2/05 and 1/8/05 not met). Immediate Staff files must contain the information and documentation specified in Schedules 2 and 4. Timescale of 20/9/05 not met. This must be addressed without further delay if enforcement action is to be avoided. Immediate Staff members must not start work until there is evidence of a returned POVA First check in the home, they must then work under constant supervision until a full CRB check is returned. Immediate Until the CRB checks arrive for the staff members already appointed they must not work without direct supervision. Immediate 27/12/05 04/10/05 15 YA34 17, Sched. 2 and 4 11/10/05 16 YA34 7, 9, 19, Sched 2 11/10/05 17 YA34 7, 9, 18, 19 20/10/05 Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 26 18 YA34 17, Sched 4 19 YA36 18(2) 20 YA39 24 21 YA41 37 22 YA43 24, 26 The staff file in respect of the manager must be held on the premises and be available for inspection at all times. Immediate Qualified and care staff must be appropriately supervised at all times. Timescale of 1/8/05 not met. This must be addressed without further delay if enforcement action is to be avoided. The registered person must undertake regular reviews of the service. The timescale indicates when this should be started. All of the significant incidents specified in Regulation 37 must be notified in writing to the Commission for Social Care Inspection. Immediate The registered person must produce a report on her monthly visits to the home and these must be sent to the Commission for Social Care Inspection until further notice and evidence that she is reporting properly on the conduct of the home. Immediate 29/09/05 24/10/05 24/10/05 11/10/05 27/10/05 Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 27 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 Refer to Standard YA7 YA11 YA23 YA36 YA39 Good Practice Recommendations All of the residents who do not have regular visitors should be referred to independent advocates. Staff should engage meaningfully with the residents, and if necessary training or guidance should be provided to facilitate this. The registered person should open an interest attracting account for the residents who have a joint account. Staff should have formal, recorded supervision a minimum of six times a year. Independent advocates should be used to help residents complete their feedback questionnaires Sycamore Lodge Care Home DS0000026475.V253922.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Nottingham Area Office 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 DS0000026475.V253922.R01.S.doc Version 5.0 Page 29 - 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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