Inspection on 15/06/09 for Sycamore Rise Residential Care Home

This inspection was carried out on 15th June 2009.

CQC found this care home to be providing an Poor service.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamore Rise Residential Care... 07/09/09

Sycamore Rise Residential Care... 02/04/09

Sycamore Rise Residential Care... 17/04/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for older people Name: Address: Sycamore Rise Residential Care Home Hill Lane Colne Lancashire BB8 7EF zero star poor service 02/04/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Christopher Bond Date: 1 5 0 6 2 0 0 9 Information about the care home Name of care home: Address: Sycamore Rise Residential Care Home Hill Lane Colne Lancashire BB8 7EF 01282864209 01282870897 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Crystal Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 23 Number of places (if applicable): Under 65 Over 65 0 0 23 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 23 23 0 The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP. Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 23 Date of last inspection 0 2 0 4 2 0 0 9 Care Homes for Older People Page 2 of 17 Brief description of the care home Sycamore Rise is a care home that accommodates 23 residents including people who have dementia. The bedrooms are mainly single rooms and most of them have ensuite facilities. There are two shared double rooms. There are two lounges, one that doubles up as a dining area. There is a lift available that serves all floors. The home is situated in a rural setting on the outskirts of Colne, Lancashire. There are good views of the surrounding countryside and some of the rooms overlook the hills around the home. There are no services in the immediate vicinity of the home. There are, however, shops and other services in the local town. Bus services into the town are limited and the home does not have its own transport at present. Information relating to the homes Service User Guide and Statement of Purpose is included in the welcome pack, which is given to all prospective residents. This information explains the care service that is offered, who the owner and staff are, and what the resident can expect if he or she decides to live at the home. At the time of this visit the information given to the Commission showed that the fees for care at the home are from GBP366.00 to GBP 413.00 per week, with added expenses for hairdressing and chiropody. Care Homes for Older People Page 3 of 17 What we found: This was a random inspection which took place on 15th June 2009. The purpose of this inspection was to monitor the service after a key inspection in April found that outcomes for residents were poor ( 0* quality rating). We asked the owner of the home to complete an improvement plan, and this was submitted to us in May 2009. We looked at how the manager of the service and the owner had addressed the requirements made of the service by the Commission. We looked at care documentation within the home and the medication systems that were in place. We spoke to four of the care staff, and a senior carer. We also spoke to three people who used the service about their experiences and care whilst living at the home. We also spoke to the visiting District Nurse about how she found the arrangements for delivering care within the home. We looked at most of the care plans during this random inspection. Work had been completed on most of these and there was evidence that the review process had improved, as many of them had reviews completed with outcome statements. There were, however, Care pans that had not been reviewed or updated and work must be continued to help ensure that everyone had a care plan that was current, up-to-date and instructive for the carers of the home. care staff told us that they were happier with the format of the updated plans as they were more instructive and informative. We spoke to the district nurse during our visit. She told us that the care staff had been more aware of what work was being done to treat pressure sores and pressure area care was being taken more seriously. Clear information was available in the care plans regarding this important area of care. A nationally recognised assessment tool was being used to assess tissue viability. and body maps were available to show where tissue breakdown was occurring. The notes from the District Nurse were now within the care plans and current care regimes were clearly visible. We were told by one of the carers that the continence advisory nurse had been contacted and that assessments had been carried out, and some of the care plans, but not all, had more information about incontinence issues and how these should be addressed. There was clearly some work to do to ensure that all of the care plans were fully updated and held current information about how to ensure that peoples dignity was upheld. The risk assessment of those people who were prone to falling had been improved and updated. Again, this needed to be carried out on all of the residents to help ensure that people lived in a safer home. We looked at the arrangements for managing peoples medicines and were concerned to find that many of the weaknesses identified at the previous inspection remain. This needs to be addressed to reduce the risk of mistakes. We again found that the homes policies and current good practice guidance were not followed in practice. On arrival at the home we again saw that most people had taken their breakfast medicines but the medicines records were not completed at the time of administration. Instead, the medicine records were completed all together at the end of the medicines round. This unnecessary reliance on memory increases the risk of making mistakes. We saw two examples where people Care Homes for Older People Page 4 of 17 had missed doses of prescribed medication because there was none left to give, run out. As previously discussed, care needs to be taken to ensure sufficient stocks of medicines are kept at the home, without overstocking. It was of concern that as previously seen, there was a lack of information about how people were supported to safely selfadminister medication. Risk assessments and care plans need to be kept up-to-date to help ensure people always receive any support they need to manage their medicines safely. We looked at medicines record keeping and found some areas that need to be addressed to help improve the clarity of these records: Where doses were not administered, the reason was not always clearly recorded. Again, we found it difficult to track changes to peoples medicines because clear records of verbal advice from doctors were not always made. In one case this meant staff were unsure whether or not, for one person, some prescribed medicines had been stopped. As previously seen there was sometimes a lack of information about the administration of medicines prescribed when required. One person was prescribed three painkillers, two of which were to be given when required; the person had no pain management care plan. Similarly, there was a lack of information about the use of prescribed creams. We found that peoples medicines needs were not adequately checked when they first came to the home. A hospital discharge list for one person included a supplement drink, but none was available at the home, staff had not made enquiries with the Presciber to see whether it was still needed. A prescribed laxative for a second person was not included on their medication administration record until nine days after they arrived. We looked at medicines storage and found that all medicines including controlled drugs were now safely locked away. As previously recommended, consideration should be given to completing regular inhouse audits of medicines to help ensure that any shortfalls are quickly identified and addressed. One of the carers showed us that the residents weight was being recorded properly to help ensure that health issues were being picked up and diet monitored properly. We found care plans, however, where this was not the case, and no weight chart was evident. One of the residents had recently been refusing food and had been referred to her doctor. The care plan didnt really contain much information about this, although the care staff could tell us more. This information had not been recorded and information still wasnt being passed on to all of the carers via the care plan. One care plan stated that weight should be recorded periodically, but this hadnt happened. Overall we found that some improvement had been made since our last key inspection but there were still areas of concern, particularly when it came to the recording of information and passing this on via the care plans so that all the people who worked at this home had the same information, and that people were being cared for consistently and thoroughly. Activities were taking place at this home, and there was evidence in the activities diary to show that some of the care staff were ensuring that activities were available. These, however, were by no means regular and there were still no specific activities available for those people who had dementia. It is important that all of the residents are able to join in Care Homes for Older People Page 5 of 17 planned activities, and those who have dementia are not excluded. This is to help ensure that people who live within this service are stimulated mentally and physically and that their interests and hobbies are addressed. Activities must be enjoyable and suitable for all. We spoke to the senior carer about activities and she agreed with us that these were still not a regular occurrence, and appropriate for all. After a serious incident at this home in March 2009 the owner of the home had taken into consideration the management of the service and the impact that this had on the outcome of this incident. Criticisms were made by the Commission regarding the actions of the manager and assistant manager following a full investigation regarding how the incident was handled by senior staff at the home. These criticisms were passed to the owner during a recent safeguarding meeting held with the local authority. The investigation is still progressing and will be fed back formally to the owner of the service. It is important for the owner of the home to ensure that the people who are using this service are safeguarded properly and that the lessons from this incident are taken into account. The manager is not now in post: the actions of the assistant manager must be addressed. We have been informed by the owner of the home that care staff now take individual breaks because of criticisms that the people who use the were not being supervised properly. It was alleged that groups of carers would go for breaks together, leaving insufficient numbers available to safeguard the interests of the residents and be available to communicate sufficiently with care professionals and visitors to the service. break times were being taken whilst we were there and sufficient care staff were available to ensure that the interests of the residents were being safeguarded and that they were being cared for consistently and properly. We looked a the environment of the service. The owner of the home told us that a lot of furniture had been ordered and a new carpet had been purchased for the lounge area. There was still a smell of urine in the main lounge and it was hoped that the delivery and fitting of the carpet would ensure that this would disappear once the old carpet had been removed and the floor cleaned. it was the owners intention to purchase a new carpet cleaner and appropriate cleaning products to help ensure that the carpets within the home remained clean and hygienic. We were also told by the owner that a new cleaning policy and regimes were being introduced encouraging clean as you go routines. As progress towards removing offensive odours was still ongoing we will be able to assess what action has been taken, and whether this has been successful, at the next key inspection. We saw some large, flat -screened televisions that were waiting to be fitted in the lounges. New pictures had already been put on the walls; these were quite well chosen and depicted people from the mid 20th century, such as Winston Churchill and Marilyn Monroe. It was hoped that these would help to stimulate conversation and bring back memories. A new carpet had been fitted in the rear hallway to replace one that was worn and dirty. There was still a need for the owner of the home to ensure that parts of the home were decorated to a good standard. He had received quotations for this work to be done. We were also informed that new beds had been purchased and were to be delivered shortly. Care Homes for Older People Page 6 of 17 It was clear that the owner of the home was working towards improving the environment of the home. More evidence of this will hopefully be available when we visit the home for the forthcoming key inspection of the service. There were adequate numbers of care staff available at the home whilst we were there, and enough to ensure that the needs of the residents were properly addressed, and their care provided consistently. The owner of the home had assured us that breaks were now being taken on an individual basis to help ensure that people were being safeguarded during allotted break times. Two people who used the service were spoken to during this inspection. Both told us that they felt that they were being cared for properly and there were sufficient staff around at all times to address their needs. One resident told us: The girls are still a bit rushed now and again but they have time to talk. I think Im being well looked after. Care staff rotas showed that enough staff were employed within this service to meet the needs of the residents. The senior carer told us that there were occasionally times when care staff rang in sick at short notice, and a replacement could not be found. No new carers had joined the care team since our last inspection. The senior carer that we spoke to was aware of the responsibility the service had to ensure that all new carers were properly inducted into the working environment, and their progress recorded. The registered manager of this service had recently resigned and the home currently did not have a manager. The owner of the home had decided to manage the service until a new manager started work on 29th June 2009. The owner wasnt available when we visited and there was some confusion as to who was in charge during this random inspection. We fed back our findings to the senior carer. There is an expectation that the owner and the new manager both take into account our findings from this random inspection, and act on them accordingly. There were things that had not been addressed since the last key inspection. However, environmentally orders had been taken and tradesmen booked to rectify matters such as fitting carpets and decorating the home. New beds and furnishings had been ordered. There were plans to move the managers office to a room on the ground floor, where the care staff can be observed and monitored regarding their performance and the manager can have more control regarding how the residents are cared for. Some changes had been made with regards to care planning and recording information. There is still a need to ensure that all of the care plans are updated and improved. Similarly the owner and the new manager need to take into account our findings regarding how medication is being administered. We found that there were still serious issues regarding this and, until these are addressed the people who use the service are at risk because of poor handling of medication. Overall, key areas had not been addressed sufficiently since our key inspection in April 2009, and timescales had not been met regarding the requirements and recommendations that were detailed on our last report. We must, however, take into consideration the changes that have occurred regarding the management of this service. We will undertake a key inspection of this service at a later date to monitor how the changes in this service are progressing. Care Homes for Older People Page 7 of 17 What the care home does well: What they could do better: The handling of medication was still poor and there were clear issues regarding administering this. This means that the people who live within this service are being put at unecessary risk by poor practice. There were weight charts on most of the care pans but not all of them. This was particularly evident on one persons care plan who had problems eating and no weight chart could be found, even though regular monitoring was specified in the care plan. This meant that this persons health was being compromised by poor practice. Similarly, although most of the care plans had been updated and reviewed there were those that had information missing. We were informed that some of the care staff had not updated these in their role as key workers. Insufficient information means that the care of some residents is being compromised and poor practice cpoud occur because of a lack of current and consistent information. The main lounge still had a bad smell, although the deputy manager told us that this should improve when the carpet is removed, the floor cleaned thoroughly, and a new carpet fitted. Similarly new furniture and beds had been purchased and, when delivered, the look of the home should improve. A home that is well furnished and decorated will help improve the well being of the residents. No registered manager was in place when we visited this service. The previous manager had been replaced and a new manager was to begin work on 29th June 2009. There was confusion at the time of the inspection regarding who was in charge of the service. This is unacceptable, and a clear and sufficient management structure should be in place at all Care Homes for Older People Page 8 of 17 times. The owner of the home explained to us that he was to manage the service unrtil the new manager commenced her role. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plan of each resident must be reviewed properly at least once a month. This is to help ensure that current health and social needs are being addressed correctly, and recorded as such in sufficient detail 29/05/2009 2 7 15 Care staff providing day to day care must have good, current and consistent information about a persons health, personal and social care needs. This is needed to help the care staff to care for the people who use the service properly. 29/05/2009 3 8 13 Those people who use the service who are deemed as in risk of falling must be adequately risk assessed, and action taken to prevent this from happening. This is to help ensure that areas of risk or danger are addressed properly and that people live in a safer home. 29/05/2009 4 8 13 Pressure area care must be recorded properly within the 29/05/2009 Care Homes for Older People Page 10 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action care plan. This is to help ensure that peoples skin condition is being assessed and any breakdown is recorded and dealt with accordingly. 5 8 13 Proper advice, support and 29/05/2009 equipment must be available for those people who use the service who have continence issues and needs. Action that is being taken must be recorded properly and fully in each persons care plan. This is to ensure that peoples dignity is being adressed and that assocoated health issues are being dealt with. 6 9 13 Staff handling medication 01/06/2009 must follow the homes policies and procedures, and adhere to current good practice guidance. And, adequate stocks of prescribed medicines must be maintained without overstocking to help ensure medicines are safely administered as prescribed. 7 9 13 Complete, clear and accurate 01/06/2009 lists of currently prescribed medicaiton, the dosage instructions and time and date of administration must be maintained for each person Care Homes for Older People Page 11 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action to support the safe administration of medication at the home. 8 12 16 Regular, planned and 29/05/2009 appropriate activities must be provided for all residents. particular consideration must be given to those residents who have dementia, and suitable activities provided accordingly. This is to help ensure that people who live within this service are stimulated mentally and physically and that their interests and hobbies are addressed. Activities must be enjoyable and suitable. 9 19 23 The owner of the home must 30/06/2009 continue with the renewal and refurbishment of the home. This is to help ensure that peole live in a pleasant environment with good quality fixtures and fittings around them. 10 19 39 (h) The owner of the home must 31/12/2008 continue with the renewal and refurbishment of the home to improve the environment for the people who live there. The residents should live in nice surroundings with nice things around them. This adds to their well-being. Care Homes for Older People Page 12 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 11 26 12 (1) (a) The manager must ensure that the home smells fresh and that unpleasant odours are eliminated. This is to help ensure that people live in pleasant surroundings. 30/06/2008 12 26 16 The owner of the home must 30/06/2009 ensure that unpleasant odours are eliminated and contributory factors regarding this are addressed properly and completely. This is to ensure that incontinence and cleaning issues are addressed and that the residents live in a pleasant, odour free environment. 13 30 18 Care staff must have a 29/05/2009 period of time where they are inducted to the workforce and shown how care practices operate. This must be recorded. This is to help ensure that the care staff have the basic skills to complete tasks properly and that people work as a team to provide good care. 14 31 10 The manager must ensure 29/05/2009 that the care of the residents is properly planned, delivered and reviewed. All aspects of health and social care must be Care Homes for Older People Page 13 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action addressed properly and the care plans must hold reference to this. 15 32 10 The manager must ensure that she is fully in charge of the home at all times. She must delegate responsibility, liaise with other agencies and ensure that all of the residents are safeguarded from harm. 16 37 23 The welfare and safety of the 29/05/2009 residents and staff must be paramount at all times. Fire safety drills must take place on a regular basis. 29/05/2009 Care Homes for Older People Page 14 of 17 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Where people self-administer 27/07/2009 medication written assessments and care plans need to be completed and kept under review to help ensure people receive any support they need to safely self-administer their medicines Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 All equipment associated with the care of people who have pressure sores should be appropriately assessed, by a person who is trained to do so, in order that it is deemed fit for purpose. A missing person procedure should be implemented should a person leave the building without the knowledge of the care staff to ensure that appropriate bodies are aware of this. Relatives must be informed of this as soon as possible. The current regulatory body must also be notified of such incidents. All aspects of mandatory safety training must be addressed Page 15 of 17 2 18 3 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations to help ensure that people live in a safe home. This includes infection control to ensure that the home is clean and people remain free from infection. Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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