Inspection on 10/11/05 for Sydenham House

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Sydenham House 02/09/08

Sydenham House 12/09/06

Sydenham House 17/03/06

Sydenham House 15/02/05

Sydenham House 29/06/04

Sydenham House 09/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Sydenham House Frederick Road Bridgwater Somerset TA6 4NG Lead Inspector Louise Delacroix Unannounced Inspection 10th November 2005 11:20 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 Sydenham House DS0000015992.V253244.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 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. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sydenham House Address Frederick Road Bridgwater Somerset TA6 4NG 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) 01278 422763 01278 433201 Somerset Care Limited Mr Michael John Vickery Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2005 Brief Description of the Service: Sydenham House is a purpose built residential care home for older people. Situated on the outskirts of Bridgwater, the home is within a housing development close to shops, a family centre and public house. The home is owned by Somerset Care Limited. The home is registered to accommodate up to 43 persons aged over 65 years for personal care. The home currently can only accommodate 42 people, reconfiguring the accommodation had meant that a former bedroom has become office space. There is an intermediate care facility for up to six persons within the overall capacity of 43 (actual 42) persons, this unit is called The Willows. The home is well maintained, comfortably furnished, and has a homely atmosphere. The home promotes an active lifestyle with a busy activities programme The home is well adapted for the current client group and has level access both inside and around the outside of the home. There is a shaft lift between floors. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced, took place over five hours and was by two inspectors. During the day, residents were seen chatting together in various seating areas around the home, spending time in their rooms or going out. As part of the inspection, records in relation to staffing, training, care plans, maintenance and fire were looked at. The manager, two members of staff and nineteen residents contributed to the inspection. One resident appeared to sum up the feelings of the majority of residents by saying, ‘They treat us ever so well’. There was also a tour of the building during which a number of the bedrooms were visited. What the service does well: What has improved since the last inspection? What they could do better: Recommendations have been made to improve the quality of information within assessments and care plans, how these are reviewed and how residents Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 6 or their representatives are involved in agreeing the content. The latter issue is an outstanding recommendation. Residents’ social and religious needs should be part of the assessment process. Further work has been recommended to improve guidance regarding meeting the health needs of residents i.e. pressure care. A minor amendment has been recommended to the recording in medication sheets for safer practice. Staffing levels should be monitored in the afternoons to ensure they meet the needs of residents. 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. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 7 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 Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,5,6 Prospective residents are encouraged to visit to enable them to make an informed decision about moving to the home. Minor changes to the assessment process will help ensure that the residents’ social interests and spiritual/religious needs are recorded. EVIDENCE: Evidence was seen in the care plans of the manager visiting prospective residents prior to their move to the home to assess their care needs. Residents living at the home confirmed that they had been able to visit before moving in. Other people said that they had used a respite stay or day care to get to know the home, which they felt had been beneficial. Several people commented that they felt that the home was ‘the best in the district’. One person said that as soon as they entered the building they knew it was right for them. Assessments do not currently cover residents’ social interests. Only one out of the four assessments looked at logged the spiritual/religious needs of the resident. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 9 The home has created an intermediate care facility within the home called The Willows. The unit was developed in partnership with the primary care trust (SCPCT); specialist services and reviews are accessed through the local health and social care services. The Willows has a separate entrance, a kitchen that is used by the residents as part of their rehabilitation and an assisted bathroom. There is a dining and lounge facility. Bedrooms are well furnished. The unit has a dedicated staff team and a staff member confirmed that the ethos is one of reablement to maximise the independence of people staying on the unit. In a letter from someone who had stayed at The Willows it stated it ‘was a super place’ and another person said how they were telling anyone who would listen how good the reablement service was. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Currently care plans do not reflect all the care and social needs of the residents and therefore do not provide clear guidance to staff regarding their approach. Residents benefit from a system of medicine handling which promotes their safety but this is not always linked to their plans of care. EVIDENCE: Four residents’ care plans were looked at in detail. Some of them contained inconsistent information or lacked guidance around managing identified risks. None of them contained the social interests of the residents and none of them had been signed by the residents to show that they were in agreement with the content. One care plan did not state how the identified religious needs would be met. In another care plan, it was not recorded whether key areas of support had been provided for the resident. Monthly reviews do take place but these have unclear outcomes i.e. they do not indicate whether the support given was successful. However, evidence was seen of another form of review, which happens less often, which did show resident and family involvement. This form of involvement is good practice. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 11 In one care plan, it was recorded that the resident was identified as high risk for pressure areas developing. However, in over two years their waterlow score, which calculates the risk of pressure sores, was only recorded twice and there was no clear guidance as to the intervention needed and the equipment used to prevent skin problems. The manager confirmed that nobody at the home had a pressure sore. Another resident used oxygen regularly but there was no clear guidance in their care plan about how and when this should be administered or the reason it was needed. Residents said that they could see their own GP when they needed to. For example, ‘They always call the doctor when I ask or need one’. They also said they had access to chiropody and other health related services. They confirmed they could see health professionals in private at the home or at the surgery. The system for handling medication is good. Medication records are complete and up to date. The system for storing medication is tidy and easily auditable. Medicines that require refrigeration are kept in a separate fridge at an appropriate temperature and the temperature is recorded daily. Controlled drugs are kept safely and accurate records kept. Staff receive appropriate training and have a good understanding of the importance of handling medicines correctly and of the medicines they are administering. Reference material is available. The home does not have a ‘homely remedies’ policy as the company’s policy prevents staff administering ‘homely’ medications such as paracetamol for (for example) occasional aches and pains. This is a pity for those residents who would either have to do without or would have to wait for a GP to write a prescription. Staff are not recording why they are giving ‘as required’ medication. This is important for care planning purposes. Residents spoke positively about how they were treated with respect by staff. A relative said that they could not speak highly enough of the staff and that they were always welcomed by them. One person gave the example that they are called by their chosen name and others spoke about staff knocking on doors or providing intimate care sensitively. Several residents said that their post was unopened and that they could make a telephone call in private. Generally, people felt that their clothes were well cared for at the home’s laundry and all said that they could see visitors in private. Toilets are lockable as are the doors to residents’ room, although several people said they did not feel the need to lock their rooms when they weren’t using them. Residents were positive about regular access to the hairdressers, who have their own facilities on site. They felt this was particularly important to them so that they felt well presented for the social events held by the home. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Residents enjoy a well-planned social life and a welcoming atmosphere for visitors. EVIDENCE: Many of the residents spoke highly of the social life at the home, which includes regular trips out and events, such as the harvest supper that relatives and friends can also attend. One resident proudly showed a photograph featuring them dancing with the manager at a social event. However, one person felt that they would prefer more activities in the evening, which would reflect their previous home life. The manager said that there was a dedicated activities co-ordinator who works full-time. Activities are well publicised and the home has a display of photos from recent events. The manager has promoted links with the local community, which includes visiting singers and musicians. Residents confirmed this. A relative said that they always felt welcomed and that it was like ‘coming home’. It was clear on the day of the inspection that residents felt that Sydenham House was their home from the way they greeted visitors at the front door. Residents said that visitors were always welcome and that extra seating could be arranged if they wanted to see people in their rooms. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 13 Three residents confirmed that they could vote if they wanted to and a number of people said they had the choice whether they became involved in the residents’ meetings. Residents said that were able to bring in their own personal possessions with them, including furniture, which could also be seen from a tour of the building. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The complaints policy is positively translated into good practice to benefit the residents and the staff group’s awareness of their duty to report abusive practice promotes the safety of residents. EVIDENCE: Sydenham House has a complaints policy that views complaints as a way of improving the overall care and services provided. As such the policy is entitled ‘Seeking your views’ which frames the complaints procedure as a positive and helpful contribution that residents can make. The complaints book showed that no complaints have been made since 2003 (the manager confirmed this was accurate) and those recorded had been dealt with appropriately and efficiently to the satisfaction of the resident involved. Some residents said that they had ‘no complaints’. Others said that if they had any problems they would ‘just tell someone and it would get sorted’. Staff demonstrated a good knowledge of what constitutes abuse and talked of their zero tolerance to it. They said if they saw, heard or had doubts about anything to do with abuse they would report it to the manager or shift leader. The home has a ‘Whistle Blowing’ policy, which the manager had a good understanding of. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,25,26 Residents live in a home that is clean and attractive, and benefit from procedures that promote the control of infection. EVIDENCE: The décor of the home is well maintained and furnishings are of a good quality with a programme of routine maintenance, including new curtains, carpets and furniture. The carpet in one communal area of the home is tried in appearance and the manager explained that this was due to be replaced on the completion of some further building works. Where lino has been used because of the health needs of the resident then it has been laid in a subtle colour to make it more discreet. Several residents spoken to were aware of the plans for the building and one felt that this would impact positively on the space available to them in their own room with the addition of an en-suite. The communal rooms are comfortably furnished and allow sufficient natural light. All the communal rooms are well used and provide friendly spaces where residents can meet together. The electric lighting in all communal areas is domestic in style. The home is non-smoking. There are seating areas outside the home by a raised flowerbed. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 16 There is dedicated communal dining and lounge space for the intermediate care facility that is separate from all the existing communal space. This area was clean and comfortable. In response to a previous recommendation, the manager said that a footplate had been purchased to be used with wheelchairs to prevent peoples’ feet from being unsupported. A resident using a wheelchair had their feet appropriately supported. The manager explained that he had access to an occupational therapist provided by the company, which is a valuable resource. The manager confirmed that all radiators and pipework are covered or protected, which was observed during the tour of the building. The hot water supply ran at 43 degrees as recommended and detailed recording now takes place to evidence safety checks each time a resident has a bath. One resident currently has no hot water in their room, which they said had been the case for sometime. The manager said this was being addressed as part of the building works and work would start the week after the inspection. At the last inspection when it was noted that not all bedrooms have wall mounted soap and hand towel dispensers. The system in place to overcome this is satisfactory. All rooms have liquid soap, and paper towels are kept in each room. Some rooms (the manager reports approximately one third) have wall mounted soap and hand towel dispensers and the plan is that these will be fitted in all rooms as part of the refurbishment/redecoration programme. The home was odour free throughout and staff were seen using protective aprons and gloves appropriately. A number of residents said that the home and their rooms were always kept clean to a high standard. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Residents are supported by a group of well-trained staff and by procedures that promote their safety. EVIDENCE: The staff rota shows that sufficient staff are on duty at all times to meet the residents’ needs. Staff say they are sometimes busy and feel overworked because of the number of day care clients (presently up to eight people on any one day) who also use this service. However, residents said that staff always have time to help them and do this well. They are described as ‘lovely’, ‘really good’ and ‘excellent’. Recent thank you letters from relatives and friends of former residents describe the staff and quality of care as ‘efficient and loving care’, ‘kindness and care’ and ‘nothing but praise for the way she was treated’. The duty roster shows that there are usually six or seven care staff on duty in the morning, two to three in the afternoon and two at night. During the day, care staff are supported by a manager, an administrator, a cook (who works until 7pm) and housekeeping staff. Staff spoken to feel well supported in the home and by the company. The pre-inspection questionnaire completed by the manager shows that 63 of staff are trained to NVQ level 2 or above. This is above the recommended 50 ratio recommended by CSCI and is commendable. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 18 Four staff files were checked. All had references, Criminal Record Bureau checks, POVA 1st checks, proof of identity and a record of the induction training provided. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35 and 38. The manager creates a friendly and open atmosphere to the benefit of residents. A minor change in procedure would ensure that residents are protected from financial abuse in relation to the handling of their personal allowances. Residents’ safety is promoted through the checks and controls that are in place. EVIDENCE: The home is well managed by a dedicated manager who has been in post since 1975. Residents appeared relaxed and at ease with him, with one person saying ‘I can talk to him just like I’m talking to you’. A number of residents said they appreciated his involvement with social activities and were clear about his role saying they could go to him with a problem. Others felt they could also go to other staff members. It was clear from conversations with the Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 20 manager and residents that he has strong links with the community, which he uses to benefit residents i.e. visits from local entertainment groups. He also acknowledges people’s former roles and achievements in life and the fact that Sydenham House is their home. Regular residents’ meetings are held with recorded minutes. It was recorded that no charge would be made for visitors’ meals because, ‘This is the residents’ home – and if you invite someone to your home you don’t charge them for coming’. A resident said that their relatives were able to stay on a regular basis for meals. Monies kept on behalf of residents are kept in separate ‘accounts’ in a safe, which only the administrator and manager have keys to. Good records of monies received and spent are kept, and internal verification takes place. Four residents’ monies were checked and were in order. The administrator was advised to ask for and keep receipts for those residents who receive hairdressing and chiropody services. Records in relation to fire checks were inspected and were in order. Any accidents that take place are recorded and monitored. Good maintenance contracts and systems are in place. All staff receive fire and induction training. Risk assessments are completed for those residents who might benefit from the use of bed rails and safety checks are now in place to meet a previous recommendation. Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 21 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 x x 2 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 x 3 x x 3 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 4 x x 3 x x 3 Sydenham House DS0000015992.V253244.R01.S.doc Version 5.0 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP3 OP7 Good Practice Recommendations Assessments should include the social interests of residents and their religious/spiritual needs. Care plans should include the social and religious needs of residents and state how these will be met. Monthly reviews should have a clearer outcome rather than a checklist of the support given. Residents or their representatives should sign their care plans to evidence their agreement with their content. Risk assessments should be in place for identified risks i.e. tissue viability, leaving the building or sensory impairment. Clearer guidance is needed in care plans regarding care for people at risk of developing pressure sores and the use of oxygen. The registered person should ensure that records are kept in relation to the administration of ‘as required’ medication in order to be able to monitor the residents condition. DS0000015992.V253244.R01.S.doc Version 5.0 Page 23 3 4 OP8 OP9 Sydenham House 5 OP27 The impact of the needs of the day-care service users in the afternoon should be monitored and reviewed to ensure that staffing levels are appropriate. 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