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Inspection on 09/06/09 for Sylvan House

Also see our care home review for Sylvan House for more information

This inspection was carried out on 9th 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 but made no statutory requirements on the home.

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

Various positive comments about the manager were made by staff and were included in the comment cards submitted to the commission such as, “The manager will always give you support and we can always go to the manager when we need support.” Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 “My manager is always here to support my developments.” “Manager always gives me constructive criticism.” “Manager will phone staff when someone calls in sick and we always get cover.” “I was not able to start work until my CRB and pova check had come back to my manager.” “We try to make it a safe and happy home for all the residents and all the staff and care for all the residents.” “If a problem arises we can always go to the manager for help and advice.” Staff showed good knowledge and understanding of the personal needs of the people living at Sylvan house. During this visit they were observed talking to people in a polite manner and showing a good rapport with people living there and with people visiting. People are asked daily what they would like for their meal and are given 2 to 3 choices for their dinner every day.

What has improved since the last inspection?

The following positive comments, were made by people during our visit, such as, One person said, “Its very nice here just thought you should know,” It was clear from meeting the people living at the service, that they had the help they needed from staff to maintain their personal cleanliness and appearance. Some people who were able to chat to me said they were happy living there and “….like the staff.” The manager and maintenance man have continued to make improvements to the homes environment regardless of the restraints such as, very minimal finances available for maintenance within the building. Various bedrooms have been painted and the maintenance man had tried to involve people in choosing their own colour scheme. He had also decorated one bathroom to a good standard and was hoping to eventually be supplied with the necessary funds to carry this standard throughout the building. As a matter of good practice some bedrooms have been provided with, “door guards” which help to keep people safe when they like to stay in their room. These are safety appliances used to safeguard people in the event of a fire. Some people living at Sylvan house had been provided with a lockable safe kept in their own bedroom which they could use to protect their own personal items. Some people were very happy with this type of safe and said they liked it being in their room.Sylvan HouseDS0000064575.V375774.R01.S.docVersion 5.2Care staff had worked hard to help people develop their own memory box were they help people collect things from the past which they use to instigate discussion and help them to reminisce.

What the care home could do better:

Some areas were noted to need action taken and further evidence to be in place to meet other standards and regulations to show how improvements would be made to the service. 1) Financial care plans and accurate and clear policies are needed for the management of the finances of the people who use the service in order to ensure they are safeguarded from any potential risk of financial abuse. People’s monies must not be stored in any company account. Records must show they are managed in their best interest if they do not have capacity to manage their finances personally. The manager must have full knowledge of the appropriate management of people’s finances so she can help safeguard people’s rights. (This is a repeated requirement in parts from our last visit to the service) 2) Improvements are needed to the environment in order to ensure that the people who use the service live in a safe, well-maintained, comfortable home. The service must develop risk assessments including environmental risk assessments for any identified hazards, including those noted within the building to show what actions the company are taking to take risks away and make the building a lot safer. These risk assessments must include all of the hazards noticed during our visit, such as, Broken window restrictors, uneven ripped and ruffled flooring, faulty staircase, the basement area with stores, open plan dirty untidy laundry, fire exit doors that lead out to a poorly maintained external fire exit staircase, uneven flooring of pavements in gardens and grounds, people at risk of falls, people being inappropriately lifted, smoking outside the kitchen area, broken and out of order toilets and bathrooms. (This is a repeated requirement in parts from our last visit to the service) A previous environmental health inspection carried out by officers from the Wirral environmental health team made requirements in February 2009. We found that the extractor fan remained broken and the flooring still had some rips to the flooring, and the fridge had a broken seal. These requirements are still outstanding. All requirements identified by the environmental health department must be carried out to prevent any further risks to people at Sylvan House. This will ensure that the kitchen will be safe and will be in a position to offer a good standard of health and hygiene in preparing foods. The manager had already developed a list of works and repairs she felt needed to be sanctioned to improve the service. These repairs and developments mustSylvan HouseDS0000064575.V375774.R01.S.doc Version 5.2 be given the right finances, risk assessments, resources and timescales so there is a development, maintenance and refurbishment plan to help improve standards at Sylvan house. This would also help keep people informed about their home. A previous contractor’s check on the water tanks in March 09 made various requirements identifying potential risks to people with sediments found in the water tanks. We found that these actions had still not been sanctioned by the provider. All requirements identified by the contractor must be carried out to prevent any further risks to people at Sylvan House. We found that staff have not had updated training in moving and handling and that they are “lifting“ people at Sylvan house. This is a very unsafe practice that puts both the person they support and the staff at risk. Staff do not have access to any of the necessary resources such as the right equipment, i.e., hoists to safely support a person who is immobile. The overall management of moving and handling is unsafe and needs complete review to make sure that both the people living there and the staff are kept safe and have the necessary guidance, training, support and equipment while at Sylvan house. It is of concern that ongoing hazards around health and safety have not already been managed by the provider. A lack of resources and expertise has led to a large number of areas within the environment putting people at risk in a registered facility. 3) Staff must be provided with the right training and skills to help them do their job and to help them to support people living at the service in the right way. A record of all training provided to staff, including skills induction training needs to be accurate, well maintained and kept up to date. The service must have the right resources to be able to organise any necessary training. A lot of training and updates are needed because many of the staff have not been provided with mandatory training as the manager did not have a training budget. Training must include, e.g. Moving and handling, safeguarding, infection control, food hygiene, infection control, a skills induction, coshh, activities, health and safety. (This is a repeated requirement from our last visit to the service) 4) Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the people living at Syl

Key inspection report CARE HOMES FOR OLDER PEOPLE Sylvan House 2 - 4 Moss Grove Prenton Wirral CH42 9LD Lead Inspector Diane Sharrock Key Unannounced Inspection 9th June 2009 12:00 DS0000064575.V375774.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sylvan House Address 2 - 4 Moss Grove Prenton Wirral CH42 9LD 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) 0151 608 1401 Prime Care (UK) Ltd Carol Dixon Care Home 22 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (22) of places Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users 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 The maximum number of service users who can be accommodated is: 22 Date of last inspection 3rd June 2008 Brief Description of the Service: Sylvan House is a large converted property situated in the Prenton area of Birkenhead, Wirral. It is close to local shops and bus routes to towns on the Wirral and Liverpool. The home offers care and support to 22 residents who are over the age of 65 years. This registration includes providing a service to 6 people who have dementia. Accommodation is provided on two floors with passenger lift and stair access. The home has some shared bedrooms. On the ground floor there are two sitting areas and a separate dining room, some bedrooms, an adapted bathroom and toilets. Outside the home there are garden areas and some parking spaces. Basement areas in the home are used as an office, a staff room, a laundry and for storage. The weekly fees for the service range from £366.17 to £395.22. Additional charges are made for hairdressing and chiropody. A service user guide and a statement of purpose, which describe the services, offered is made available to people who are interested in using the service, their relatives and professionals before a person comes to live at Sylvan House. A copy of the most recent inspection report can be obtained from the manager. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We carried out an unannounced visit to the service on the 9th June 2009 lasting 8 hours. These visits involve measuring a number of standards considered as important by the commission. All key standards for this type of service are highlighted in bold in the relevant sections of this report. We gathered information for this visit in a number of different ways. ‘Case tracking’ was used as part of the visit. This involves looking at the support a person gets from the staff, including their care plans, medication, money and their environment. Time was also spent meeting people living there and the staff on duty. Two of the people living in the service were case tracked as part of this visit. We met most of the people living there in the main lounge and spoke with 5 of the staff on duty. Before our visit we sent out survey forms to Sylvan House. Members of staff completed these and their replies helped us with planning our visit and in writing this report. Five staff had submitted comment cards to us with their opinions about the service. The manager advised that they had not received any comment cards for people living there so she agreed to download copies from our website to give people the opportunity to fill a comment card in and send to our department. We had not received any up to the time of writing this report. The manager completed a questionnaire that we had sent before our visit. Information from this was again used by us to plan this visit and in writing this report. We advised the manager that this questionnaire should be redone so that all sections are completed and to show what actions they were taking to improve services at Sylvan house. What the service does well: Various positive comments about the manager were made by staff and were included in the comment cards submitted to the commission such as, “The manager will always give you support and we can always go to the manager when we need support.” Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 6 “My manager is always here to support my developments.” “Manager always gives me constructive criticism.” “Manager will phone staff when someone calls in sick and we always get cover.” “I was not able to start work until my CRB and pova check had come back to my manager.” “We try to make it a safe and happy home for all the residents and all the staff and care for all the residents.” “If a problem arises we can always go to the manager for help and advice.” Staff showed good knowledge and understanding of the personal needs of the people living at Sylvan house. During this visit they were observed talking to people in a polite manner and showing a good rapport with people living there and with people visiting. People are asked daily what they would like for their meal and are given 2 to 3 choices for their dinner every day. What has improved since the last inspection? The following positive comments, were made by people during our visit, such as, One person said, “Its very nice here just thought you should know,” It was clear from meeting the people living at the service, that they had the help they needed from staff to maintain their personal cleanliness and appearance. Some people who were able to chat to me said they were happy living there and “….like the staff.” The manager and maintenance man have continued to make improvements to the homes environment regardless of the restraints such as, very minimal finances available for maintenance within the building. Various bedrooms have been painted and the maintenance man had tried to involve people in choosing their own colour scheme. He had also decorated one bathroom to a good standard and was hoping to eventually be supplied with the necessary funds to carry this standard throughout the building. As a matter of good practice some bedrooms have been provided with, “door guards” which help to keep people safe when they like to stay in their room. These are safety appliances used to safeguard people in the event of a fire. Some people living at Sylvan house had been provided with a lockable safe kept in their own bedroom which they could use to protect their own personal items. Some people were very happy with this type of safe and said they liked it being in their room. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 7 Care staff had worked hard to help people develop their own memory box were they help people collect things from the past which they use to instigate discussion and help them to reminisce. What they could do better: Some areas were noted to need action taken and further evidence to be in place to meet other standards and regulations to show how improvements would be made to the service. 1) Financial care plans and accurate and clear policies are needed for the management of the finances of the people who use the service in order to ensure they are safeguarded from any potential risk of financial abuse. People’s monies must not be stored in any company account. Records must show they are managed in their best interest if they do not have capacity to manage their finances personally. The manager must have full knowledge of the appropriate management of people’s finances so she can help safeguard people’s rights. (This is a repeated requirement in parts from our last visit to the service) 2) Improvements are needed to the environment in order to ensure that the people who use the service live in a safe, well-maintained, comfortable home. The service must develop risk assessments including environmental risk assessments for any identified hazards, including those noted within the building to show what actions the company are taking to take risks away and make the building a lot safer. These risk assessments must include all of the hazards noticed during our visit, such as, Broken window restrictors, uneven ripped and ruffled flooring, faulty staircase, the basement area with stores, open plan dirty untidy laundry, fire exit doors that lead out to a poorly maintained external fire exit staircase, uneven flooring of pavements in gardens and grounds, people at risk of falls, people being inappropriately lifted, smoking outside the kitchen area, broken and out of order toilets and bathrooms. (This is a repeated requirement in parts from our last visit to the service) A previous environmental health inspection carried out by officers from the Wirral environmental health team made requirements in February 2009. We found that the extractor fan remained broken and the flooring still had some rips to the flooring, and the fridge had a broken seal. These requirements are still outstanding. All requirements identified by the environmental health department must be carried out to prevent any further risks to people at Sylvan House. This will ensure that the kitchen will be safe and will be in a position to offer a good standard of health and hygiene in preparing foods. The manager had already developed a list of works and repairs she felt needed to be sanctioned to improve the service. These repairs and developments must Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 8 be given the right finances, risk assessments, resources and timescales so there is a development, maintenance and refurbishment plan to help improve standards at Sylvan house. This would also help keep people informed about their home. A previous contractor’s check on the water tanks in March 09 made various requirements identifying potential risks to people with sediments found in the water tanks. We found that these actions had still not been sanctioned by the provider. All requirements identified by the contractor must be carried out to prevent any further risks to people at Sylvan House. We found that staff have not had updated training in moving and handling and that they are “lifting“ people at Sylvan house. This is a very unsafe practice that puts both the person they support and the staff at risk. Staff do not have access to any of the necessary resources such as the right equipment, i.e., hoists to safely support a person who is immobile. The overall management of moving and handling is unsafe and needs complete review to make sure that both the people living there and the staff are kept safe and have the necessary guidance, training, support and equipment while at Sylvan house. It is of concern that ongoing hazards around health and safety have not already been managed by the provider. A lack of resources and expertise has led to a large number of areas within the environment putting people at risk in a registered facility. 3) Staff must be provided with the right training and skills to help them do their job and to help them to support people living at the service in the right way. A record of all training provided to staff, including skills induction training needs to be accurate, well maintained and kept up to date. The service must have the right resources to be able to organise any necessary training. A lot of training and updates are needed because many of the staff have not been provided with mandatory training as the manager did not have a training budget. Training must include, e.g. Moving and handling, safeguarding, infection control, food hygiene, infection control, a skills induction, coshh, activities, health and safety. (This is a repeated requirement from our last visit to the service) 4) Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the people living at Sylvan house. These reviews should include the opinions of both staff and the people living there. There must be evidence in place to show why staffing levels were reduced following our last visit in the afternoons from 3 staff to just 2 care staff on duty. Staffing levels should also be reviewed regarding the necessary resources and hours needed for developing and providing activities and for the ongoing laundry of clothes and linen. Accurate information and clear records must be accessible and available at the service to show how many people live there. This is necessary for the health Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 9 and safety of the building and it is necessary for the ongoing reviews needed in assessing the staffing levels to support people. (This is a repeated requirement from our last visit to the service). 5) Care plans need to be developed to include all aspects of each person’s social needs and requests. This will help to show that staff and people living at Sylvan house have enough information to show how their needs will be met. The service must have the necessary resources, staffing levels and an activities budget to help provide good support socially to benefit people’s quality of life. Some people living there told us they were bored and would like to do more; some people said they would love to go outside the service. Staff told us there had been no organised trips for people living there for over a year despite people requesting trips out. (This is a repeated requirement from our last visit to the service) 6) In order to safeguard the people who live at Sylvan House a robust recruitment procedure must be in operation at all times. Records must contain evidence that volunteer staff have been appropriately checked before they begin work at the service. (This is a repeated requirement from our last visit to the service) 7) The statement of purpose and service user guide must be updated and must be accurate so that everyone has enough information to make decisions about Sylvan House and are kept up to date with all aspects about the service. The updates must include the management of the service regarding, e.g. Activities on offer, the fees charged the staffing levels, staff training and skills, the management of peoples finances, the facilities and the conditions of registration regarding dementia care. 8)The aqaa must be resubmitted to give the commission enough information to show what the provider is doing about improving standards in the service including the health and safety and management of Sylvan House. 9) The responsible person must make sure that all regulation 26 visits are carried out monthly and reports produced to show there are regular company checks on the standards offered within the service. 10) The provider must look at what support and resources he is able to realistically provide as the manager is unable to safely and appropriately manage the service without these necessary resources. 11) Staff had mixed opinions about working at Sylvan house and it was clear that the moral of a lot of staff was low because they felt they had grievances about their changes to employment issues involving pay and sickness benefits and holidays. The provider must review staffs opinions and look at what actions can be taken to improve the moral of the current work force to ensure a stable staff team continues to work at the service. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 10 12) We have requested that the provider produces his company accounts and current budget for 2009/2010 to show how the service is being managed financially and to show evidence of the services financial viability to offer an appropriate and safe standard of service. 13) The staff must have access to a full list of updated policies and procedures to help them provide the right support and guidance in working at the service. Policies must include access to e.g., appropriate moving and handling procedures in line with relevant moving and handling legislation, environmental risk assessments, financial management and support of peoples money, mental capacity act, activities and social support, staff training needs and development, infection control and laundry procedures. 14) There should be a lot of development and consultation with the people who live at the service and their relatives around important issues affecting Sylvan house they should include eg. Plans for access to suitable activities and trips out, review of menus and developments needed within their environment and garden area. A development plan should be produced and shared with people, staff and relatives to show what plans are taking place regarding their home and regarding feedback to any of their requests and suggestions. People should be given feedback to the company questionnaire they completed and told what the provider will do with their comments and suggestions. 15) Due to the repeated concerns raised during our visit we have arranged a senior management review within our department CQC (Care quality commission) to discuss responses to failings at the service. We have also contacted other relevant authorities following our “sharing of information policy” to obtain their opinions regarding their areas in, environmental health, fire safety and the local authorities contracts and monitoring department. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 11 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 12 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 Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4, People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate information and assessments are carried out to people moving into Sylvan House which helps to make sure that peoples needs are assessed so that they can be confident of meeting the person’s needs. EVIDENCE: An information brochure about the service is available to tell people about Sylvan House and support they can expect. This helps everyone to decide if Sylvan House is the right place for the person to live in and if their needs and choices can be met there. This brochure is called a statement of purpose and was found to be in need of being updated as we could not evidence some of the claims made E.g. this document had no record of the fees charged. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 14 This document stated they, “…….have a wide range of activities….” We could not evidence this during our visit as activities were poorly resourced. This document also advertised that they have 2 volunteers who visit the service. Again we found this information to be incorrect. Staff told us they have just one volunteer who visits each week for 1 hour and following our visit the provider has contacted us to say this person is a visitor and not a volunteer. The statement of purpose gave no information to people about the management of their finances or the staffing levels they can expect. It gave a list of training offered to staff but this wasn’t evidenced during our visit. This document advised people that it was registered for, “…. 22 frail elderly residents but can include dementia within that total.” The service had previously been registered to only be able to admit up to 6 people with dementia but people have not been given this information in the statement of purpose. This document must always offer accurate information about the service to help people make informed choices and decisions about Sylvan house. The aqaa (pre inspection information questionnaire) submitted to our department before our visit, stated “Any new service user admitted has an initial assessment to their personal and health needs and a comprehensive care plan is developed….” We found this information to be in place for people recently admitted when we looked at care records. We looked at a care plan of a new person who had been admitted to the service following our last visit. Records showed that the staff carried out a pre admission assessment prior to the prospective person being admitted. This information was then used to form the basis of a care plan to support the individual. As a matter of good practice staff had also developed the use of a “pen picture.” These records helped people to find out about a persons past life and all of the things important to them. We also received five staff comment cards who all felt they received enough information about the people at the service to help them support each person Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not have the right training, skills or equipment to be able to safely support people with risks associated with their immobility and falls which has resulted in people being put at risk. EVIDENCE: We looked at three care plans during our visit. Following our last visit the staff advised us that they had worked hard to develop and update peoples care plans. Care plans contained some information about the support people need and gave some information about how to provide this. However, there was limited information about how the service identifies and meets people’s needs when there are changes to their condition and they have various risks such as moving and handling a person who becomes immobile. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 16 Staff had not received updated training in moving and handling and only had access to an old out of date policy called, “lifting and handling”. Staff did not have access to any type of moving and handling equipment. Staff explained that this meant they had no choice but to lift people who could no longer walk. One plan and risk assessment actually advised staff to carry out this unsafe practice. The manager agreed to stop the practice of staff physically lifting people until she had the right training and equipment in place. The manager also advised us that she would contact other agencies for advice such as the local district nursing team who regularly visit Sylvan House each week. This unsafe practice of “lifting” people must be addressed. This will make sure that staff have the right information and training to support people in the right way and not continue to put themselves or people they support at risk. Following our previous visit the manager had developed some plans so that various risks could be identified in their care plan e.g. the use of bed rails. However one plan just had a running list of falls that occurred for one person. The plan did not have a risk assessment to show what consideration or actions could have been taken to try and reduce the level of falls to improve on this person’s safety. We also noted in reviewing training records and in discussion with staff that they had not received updated training in managing risks and in developing risk assessments. Staff need certain training to help give them the right skills to appropriately and safely support people. During our visit we noticed some improvements to previous practices especially regarding the storing and recording of medications. Staff who support people with their medication have received training in dealing with medications. Medications were found to be stored and recorded correctly, with clear records of medication received and given or not given. This helps to reduce the risk of mistakes occurring and provides a clear audit trail to check people receive their medication correctly. The manager did not have any sample signatures from the staff designated to administer medications. The manager should have access to this as a matter of good practice to help with the ongoing audit of records and match to was on duty. We noticed 2 lots of medication that were no longer recorded on the person’s medication charts but were still stored in the medication cupboard. The manager felt this was an oversight and agreed to return the medication to the local chemist which she felt was no longer prescribed. Regular audits of the Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 17 medication procedures would help to identify areas like this and help to continue improvements overall in the management of medications at the service. Some of the plans were organised and covered some aspects of the person’s personal and healthcare and included some information on, e.g. “personal care/healthcare/medication/ dental care/ support being weighed/ dementia, with evidence of support with appointments to dentist and doctors/ dietician/ and chiropodist. We looked at three care plans during our visit. We found there was limited information about how the service identifies and meets people’s social care and support. There was little information to show how they would support people to choose and aspire to have an active social life both in and outside the home. This meant that the staff and people living at Sylvan house have not got enough information to show how their social needs would be met. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff provide basic support to people with limited resources to try to meet their social needs. EVIDENCE: The services aqaa submitted to our department before our visit stated, “While trying to employ an activities coordinator, our staff on duty perform activities with residents such as light exercises, foot spa and beauty afternoons, and sing a longs, skittles and painting. We have purchased memory boxes and are in process of filling them. A sensory box has also been purchased and filling them up with items such as old fashion soap etc.” During our visit we were able to see evidence of some parts of this statement regarding activities however we evidenced poor input and resources designated to developing activities at Sylvan house. We noticed that the reception area displays large posters with daily activities offered. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 19 However the “Monday” poster said they do bingo and staff explained they do not offer this anymore as people at Sylvan House don’t really like it. The statement of purpose advertised they have, “A homes policy on Therapeutic Activities….activities with staff on a regular basis….. going for walks….Outings.....all outings are geared to the service users needs and capabilities and due to this a limited number of service users can go on any one outing……..We would be delighted to arrange more if demand increases.” We found no evidence during our visit to support this claim. Some staff told us that there had been no trips out of the building for over a year, despite people telling staff they would like to go out. Feedback should always be given to people at the service. Accurate information must always be available and updated so that people have the right information to make choices at the service. Some staff seemed vague as to what activities are provided and said they mainly try to arrange activities in the mornings when they have 3 staff on duty but some felt it depended on what type of day they were having. Staff explained they tried to do their best but advised they did not have any extra hours given to organise activities and on top of the care role they also had do carry out laundry duties as the service does’ not have a laundry assistant. Some people living at Sylvan House gave mixed views on activities available to them, e.g. “..there’s not much to do, not many people to talk to…” Some people said they would love to go outside. Another person said they would love to go out if it was arranged but they felt that the staff just don’t have the time. One person said that, “….. years ago we used to sit out all the time and have barbeques; we don’t do that anymore really.” In looking at their care plans, staff had not included these people’s views and could not show how they were being supported in their personal requests to go on trips outside of the service. Some care plans did have brief details about a persons social needs however there was no evidence to show how their plans had been used to develop the activities programme. Some staff gave suggestions that they would like to see more getting done for the people especially in being able to go out more. Staff comment cards included statements such as, “An activity co-ordinator would be good to encourage and motivate everyone to try and do more”. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 20 “To improve on activities we already have.” Following our last visit the manager had developed regular records of what activity the staff had provided with a list of who had attended the activity. The records helped in showing how staff were trying to offer some event. However the records showed they couldn’t always commit to offering an in house activity every day. We met people living at Sylvan House who were able to talk about what they had done that day and some were looking forward to their tea. Some people had been to see the hairdresser which they liked to do each week. One person said, “Its very nice here just thought you should know,” We sat with a lot of people sat in the lounge who all looked well groomed and had visited the hairdresser. It was clear from meeting the people living at the service, that they had the help they needed from staff to maintain their personal cleanliness and appearance. Some people who were able to chat to me said they were happy living there and “….like the staff.” Observations of people living at sylvan House with the staff showed that they were happy and relaxed in their company. The garden area had 3 garden tables but we noticed there were various areas in need of repair to make this part of the building safe for people to relax and enjoy. Some of the flooring and flags were uneven and posed as a potential trip hazard. The garden was open plan and did not offer a safe gated area especially for people supported with dementia. Staff felt that for some people the garden could be dangerous as they felt they could just wander off as they didn’t have a gate or fencing to prevent people getting lost and wandering to the main road. The manager did not have access to any funds to enable her to develop this area to provide a safer garden to meet people’s needs. The aqaa told us that they had various plans but they could not supply any definite dates for their plans which were to, “To recruit an activities coordinator and encourage visits to parks and museums…. To enhance the garden area so that residents can spend some time there.” A long standing problem identified at our last visit was regarding the services inability to employ an activities organiser. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 21 During our visit we identified that the staff worked hard to try and do what they could but they had not been given any extra care hours or training to arrange activities. The service did not have any type of activity fund which highlighted a lack of investment and lack of priority in providing the right social support to meet people’s needs and requests. The manager had developed questionnaires for people living at Sylvan House and showed us a sample of some of the responses she received. Some had no dates or evidence of when they had been carried out. This is necessary to show ongoing discussions and reviews with people to elicit their opinions and views. We noticed that various people had made a number of suggestions on the questionnaires and said they would like to have trips out and suggested picnics and to have more activities. There had been no summary of the findings contained in the questionnaires. People did not know whether any of their comments would change anything and they had not been given any feedback about their comments. The service must have the necessary resources, staffing levels and an activities budget to help provide good support socially to benefit people’s quality of life while living at the service. The dining room offered a domestic style area, with nicely laid tables with linen table clothes and condiments and plenty of seating. Some people commented on the quality of the food and said it was “ok” “the food is ok…but I’m a fussy eater.” “We are very lucky we are well looked after.” One person said she gets asked everyday what does she want to eat. She said she has everything she needs. We looked at the minutes of 2 meetings for people living at Sylvan House dated, 16/4/08 and 28/8/07. They were not being organised on a regular basis and we could find no records of a meeting organised for 2009. There was limited evidence to show that people’s opinions had been sought on a regular basis. The kitchen was equipped with domestic style appliances and staff helped provide meals based on the daily choices offered. The cook had an environmental health inspection in February 2009 advising on a number of requirements of repairs to be carried out. During our visit we noticed the requirements hadn’t been carried out. The cooker’s extractor fan was still broken, the seal on the fridge was broke and the flooring remained chipped and had some rips to it. Staff working in the Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 22 kitchen had still not been provided with updated training in food hygiene. Ongoing hazards can create potential risks to the safety and management of food hygiene. It is of concern that ongoing hazards around food hygiene have not already been managed by the provider. All areas identified needed actions taken to help improve the food hygiene standards within the kitchen. These concerns were shared with the environmental health department who will review the requirements initially served by their department in February 2009. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place for safeguarding people are poorly managed and resourced which has potentially put people at risk. EVIDENCE: The services aqaa submitted to our department before our visit stated, “The complaints are recorded in the complaints book but at present not received any. Updating our policies and procedures regularly. We could do better by enrolling staff on a refresher POVA training program and also explore training around physical and verbal aggression. Bank Statements relating to service users personal allowances are now kept at the care home and a clear account is maintained to protect them from financial abuse.” During our visit we found that the information contained in the services aqaa didnot really tell us how they had evidence in place to show improvements in the management of peoples finances. This was a repeated concern and was also pointed out at our previous visit were a requirement was made over 12 months ago to improve the management of peoples finances. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 24 We looked at two peoples finance records to see how they were being stored and looked after. The manager advised that the records were now accessible to her but she was not involved in the management of peoples finances. The records were unclear as to how they were being managed and unclear regarding transactions. We looked at bank statements relating to a company account. It was unclear regarding how many people had their own personal money stored in this account, there was no record, or policy to tell us this.The commision and the care home regulations are clear that people’s monies must not be stored in any company account. We looked at one person’s care plan and noted it did not have a financial risk assessment or care plan to support the person in making decisions as to how to spend their money and in choosing who they wanted in managing their monies. There was no policy to describe the current processes ( which is in direct contrast to what the aqaa says about updating the services policies.) We looked at a basic policy kept in the policy file called, “ Service users money and financial affairs” which advises, “ A risk assessment is carried out to ensure that practice in this area is robust and protects the interests of both staff and service users. On any occasions when staff do have to intervene in a service users financial affairs this must be with the consent of the service users and the care homes manager and it must be clearly in the best interest of the service users to do so…... “ There was no records showing why decisions had intially been made for the service to manage the persons monies and we found no evidence to support this policy during our visit. Detailed financial care plans and up to date policies are needed for the safe management of the finances of the people who use the service. This will help to show they are safeguarded from any potential risk of financial abuse and that their rights are protected. Records must show they are managed in their best interest if they do not have capacity to manage their finances personally. The manager must have full knowledge of the appropriate management of people’s finances so she can help safeguard people’s rights. Since our last visit to the service we had received one complaint made to the commission. The anonymous concerns were referred to the provider to investigate who felt it was unsubstantiated. We discussed the recent anonymous complaints with the manager. We noted the manager did not have access or information regarding the provider’s outcomes to his investigation and the response sent to our department. The Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 25 manager must have the necessary records and information available to her to assist her in effectively managing the service that she is responsible for. Staff said in their comment cards and in discussions with us that they are aware of the action they need to take if anyone raises concerns regarding the service. Some people we met were able to tell us that they would speak to staff if they were unhappy, one person said, “I would let the staff know if I’m worried about anything. “ However some people said they don’t really get to spend a lot of time with the staff because they felt they were always so busy, but felt the staff were ok. We looked at a sample of staff training records and in talking to staff we found that several people had not received safeguarding training or updates to previous training. The services own policy actually stated, “….Abuse awareness is covered within the induction and ongoing training received by staff. All staff will therefore be in a position to recognise potential for vulnerable adults subject to financial abuse and will recognise the need to ensure that robust systems are in place to prevent this……” The manager received information on the day of our visit advertising free training in this subject and advised us that she would be trying to secure safeguarding training for some of the staff. The manager advised that they did not have access to a budget for training, hence why she tried to secure as much free training as possible. This point was not highlighted in the services aqaa and no information was given to tell us that they did not have a training budget and that staff had not been supplied with mandatory training. The aqaa did not tell us that some staff had never received training in safeguarding. All staff including new staff, must have the necessary training that is up to date in safeguarding so they have the right skills and knowledge to always be able to protect and safeguard the people they support. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25,26, People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the health and safety of the environment is poorly resourced leading to a number of hazards that are putting people at risk in their own home. EVIDENCE: The services aqaa submitted to our department before our visit stated, “the domestic staff have an improvised check list for all areas of the home and adhere to it. All residents rooms are personalised with their own furniture when they moved in. The home is kept clean and tidy and smells fresh, As resident bedrooms have been vacated they have been refurbished to suit new residents and also encouraging them to bring their own furniture. Our plan for the next twelve months is to enhance our garden area , refurbish toilet and bathroom upstairs on the first floor.” Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 27 During our visit we found that the information contained in the services aqaa didnot really tell us how they had evidence in place to show improvements in the overall safety, maintenance and management of the service. There was no planned date to enhance or make safe the garden area and no planned dates for repairs of the toilet and bathroom that were out of order. The manager showed us around the service and one person offered to show us their bedroom during our visit. This person was happy with their room and said that she relied on her family to get all of her belongings together and to get the room the way she wanted it. Some peoples bedrooms were more personalised than others as some people had the ability to bring their own furniture which matched their décor and enhanced their living area. Other people were provided with basic facilities that were all clean and tidy. Some had been provided with old mismatched bedroom furniture, some had broken doors and mismatched colour schemes and linen and carpets. Some of the people we chatted to said they liked their home and said they liked their bedroom. One person commented that many years ago they use to have barbeques outside in the garden but they felt this didn’t happen anymore and that not many people sit out in the garden. As a matter of good practice some bedrooms had been provided with, “door guards” which help to keep people safe when they like to stay in their room. These are safety appliances used to safeguard people in the event of a fire. Some people living at Sylvan house had been provided with a lockable safe kept in their own bedroom which they could use to protect their own personal items. Some people were very happy with this type of safe and said they liked it being in their room so they could look after their own belongings and feel comfortable about their safety. Some of the communal areas that we saw were kept clean and tidy and looked presentable and comfortable to live in, including the two lounges and a dining room. The areas that were not clean included the basement area, the store room, the laundry and basement store and the linen cupboard. There were various areas around the building were we could see a whole list of hazards around the service. The manager herself had already identified a list of repairs and jobs needing to be done but she did not have the funds, risk assessments or the authority to take the appropiate actions for repairs as she did not have a budget for this. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 28 Some of the toilets and bathrooms had no covers to the windows which made them less private. Some of the toilet floors were scraped and worn and looked unsightly. We found that one bathroom and toilet had been locked and out of order for several months despite the statement of purpose still advertising to offering 6 toilets. The manager just didn’t have the funds available to her to organise these repairs. This has led to less choice and availability of bathrooms and toilets left to people. One locked bathroom had a new bathroom suite installed aproximately 12 months previously but the room couldn’t be used as the job hadnt been fninshed with uncovered pipes and flooring still needing to be laid. One bedroom carpet was worn and stained and ruffled in parts which presented as a potential trip hazard. The staff advised that they have to wait for the provider to release additional funds to be able to change carpets and fund major purchases. The manager explained that she was ordering a carpet for that particular room but could not supply a date for when this would be done. Another bedroom was found to have an ordinary plastic wrapper around the mattress that had not been removed. This was discussed with the manager as it was clear it wasnot a specialised semi permeable mattress cover and potentially put people at risk with their skin. This type of thick plastic can also make the mattress uncomfortable to sleep on. The manager agreed to check all of the mattresses and would take the necessary action of removing any inappropriate cover to the mattresses on peoples beds. There was no maintenance, decorating and refurbishment programme for the service, so people were unsure what plans were in place for their home. The lack of funds ownly served to hinder the manager and she was unable to offer a safe well managed environment. The maintenenace man and manager explained they had worked hard in using small amounts of money from the services own petty cash to try and keep the building clean and painted as there were no additional funds to purchase wallpaper. There was no evidence of a planned approach to the ongoing investment needed for the upkeep of the environment. There was no evidence of what funds were available for the future to ensure the building was safe throughout. Improvements are needed to the environment in order to ensure that the people who use the service live in a safe, well-maintained home. The service did not have any environmental risk assessments for any of the identified hazards which means people are being put at risk by poor management of hazards. These risk assessments must include all of the hazards noticed during our visit, such as, Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 29 Broken window restrictors, uneven ripped and ruffled flooring, one bathroom and toilet had flooring that was ruffled and not sealed to the floor making it potentially unsafe and a trip hazard. Faulty staircase that was loose at the wall, the basement area with stores were dark and untidy, dirty and untidy laundry and linen cupboard, fire exit doors that lead out to a poorly maintained external fire exit staircase, uneven flooring of pavements in gardens and grounds and basement, smoking outside the kitchen area. The staff had not received training in health and safety or risk assessments. This meant staff did not have the right skills to safely manage and maintain the environment on top of having no budget for repairs. It is of concern that ongoing hazards around health and safety have not already been managed by the provider. The lack of resources and expertise has led to a large number of unsafe areas within the environment putting people at risk in a registered facility. The local authority’s environmental health department carried out an in February 2009 and made a number of requirements needing to the kitchen. These requirements should have already been carried out to make sure the kitchen was safe and offered a good standard of health and hygiene in preparing foods. We found during our visit that the extractor fan remained broken and the flooring still had some rips to the flooring, and the fridge had a broken seal. This meant that people were put at risk and the provider had no evidence to show due regard in taking the right actions following legal requirements to improve matters within the kitchen area. A previous contractor’s check on the water tanks in March 09 made various requirements identifying potential risks to people with sediments found in the water tanks. We found that these actions had not been sanctioned by the provider as the manager did not have any funds or authority to grant the improvements. This meant that yet again people were put at risk and the provider had no evidence to show due regard in taking the right actions to prevent any risks to people at Sylvan House. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 30 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment practices and the management of staffing levels and training at the service do not fully safeguard and support the people who live at Sylvan House. EVIDENCE: The services aqaa submitted to our department before our visit stated, “We always have enough staff to cover for the amount of residents that we have at present .We have one Bank staff that we use in case if we were to have a shortfall. We encourage staff training in all areas. New staff have induction training at the care home which meets skills for care standards. We have regular staff meetings and these are documented. Staff rotas show one senior care assistant and two care assistants on the 8am to 3pm shift and the manager. On the 3pm to 10pm shift we have one senior care assistant and one care assistant. On the 10pm to 8am shift we have two awake care staff. Three overseas staff have been employed at the care home. A Training plan has been developed and gaps in training have been identified and courses booked. All senior care staff have received medication training….” Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 31 During our visit we found that the information contained in the services aqaa didnot really tell us how they had evidence in place to show improvements in the overall staffing levels and in the management of the staff training skills. We looked at a sample of 2 staff files including a newly employed member of staff to see what checks and what training they had been supported with while employed at Sylvan house. One staff member had not been provided with a skills induction training as advised at our last visit, even though the services aqaa states it is provided for new staff. In speaking to staff and in looking at staff files we found that a lot of staff had not been provided with mandatory training including domestic staff employed at the service. The manager and provider had developed an organisational training plan which was not dated. It had a list of staff with NVQs (this means a qualification in care) but we did not see their certificates. We discussed the training plan with manager as she was unsure what the crosses in the staff boxes meant and wasn’t sure whether it meant staff had received the training or were due to have the training. We noted that the manager did not have a budget for training. The service did not have the right resources to be able to organise necessary training. The manager had managed to secure some recent free training with 3 staff booked the day after our visit to do, e.g., improving dementia care; first aid was booked from June 09 for some staff. Staff are not being provided with the right training and skills to help them do their job and to help them to support the people living at Sylvan house in the right way. Good management of staff training is needed to demonstrate that staff are being provided with training that is suitable for the work they perform. (This concern was also noted at our previous visit and becomes a repeated requirement at this visit.) Some staff had not received necessary basic mandatory training to do their job in, e.g., Moving and handling, safeguarding, infection control, food hygiene and coshh, activities, health and safety. Yet the services statement of purpose states that, “The home also send selected staff on external training for such topics as Food hygiene, Lifting and handling, First aid……” We noted that the aqaa submitted to us, was left blank with no answers to questions around whether staff had training in “infection control” or, “malnutrition.” However it did state there was no staff training in food hygiene. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 32 This document must be resubmitted to give the commission enough information to show what the provider is doing about improving standards in the service including the training needs of staff. Following our concerns and requirement made at our last visit around staffing levels we noted in the aqaa and during our visit that staffing levels had been reduced further in the afternoons to just 2 care staff on duty. There was no information available to show why this had been done. There must be evidence in place to show why staffing levels were reduced following our last visit in the afternoons and how the current staffing levels can safely meet the needs of people at the service. In discussions with staff we noted they were also responsible to organise activities, do laundry if needed and to care for one person who has already been identified as needing 2 people for their care. The manager and provider did not have any evidence to show how the staffing levels had been calculated or how they are shown as being able to meet the ongoing dependencies of the people living at Sylvan House. Staffing levels have not been kept under review in order to make sure that staffing levels are appropriate to the needs of the people living at Sylvan House. (This is a repeated requirement from our last visit to the service). During our visit we were told that there were 18 people living at Sylvan House. The provider has had various discussions with our department following our visit and advised they have just 16 people living at the service. Accurate information and clear records must be accessible and available at the service to show how many people live there. This is necessary for the health and safety of the building and it is necessary for the ongoing reviews needed in assessing the staffing levels to support people. There have been no reviews off staffing levels with the opinions of both staff and the people living there. Some staff felt in their opinion the staffing levels were, “..ok…and not too bad…but it depended on what kind of day they were having…” Some advised, “The time extra staff are needed is if a client becomes ill, then more care and attention on a one to one basis to care of client is needed.” “Manager will phone staff when someone calls in sick and we always get cover.” We chatted to people during our visit who were happy with the staff but felt they didn’t see enough of them as they were always busy, one person said, Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 33 “They are helpful.” Some people living there had commented that they see staff come and go and then they have to wait for new staff to arrive. Most people who were able to offer there opinion were happy with the staff but felt they were very busy. Staffing levels must also be reviewed regarding the necessary resources and hours needed for developing and providing activities and for the ongoing laundry of clothes and linen. Staff had mixed opinions about working at Sylvan house and it was clear that the moral of some of the staff was low because they felt they had grievances about their changes to employment issues involving pay and sickness benefits. Staff felt steps were needed to be taken to review their opinions. Actions must be taken to improve the moral of the current work force to ensure a stable staff team continues to work at the service. Various positive comments from staff enclosed in the comment cards submitted to the commission included e.g. “I was not able to start work until my CRB and pova check had come back to my manager.” “We try to make it a safe and happy home for all the residents and all the staff and care for all the residents.” Following our last visit we made a requirement around the need to have safe recruitment checks in place for volunteers who visit the service on a weekly basis. (The facility of volunteers was advertised in the statement of purpose). In discussions with staff we found that this requirement had not been carried out and our department had not been informed as to why they chose not to carry out the actions clearly laid out in their requirement. The service now has just one volunteer but there was no personnel file and no police check to show any type of management or safety check was in place. In order to safeguard the people who use the service a robust recruitment procedure must at all times be in operation. Records must contain evidence that volunteer staff have been appropriately checked before they begin work at the service. (This is a repeated requirement from our last visit to the service) Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 34 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38, People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of Sylvan House and the systems in place for quality assurance do not fully support the wellbeing of the people who use the service. EVIDENCE: The services aqaa submitted to our department before our visit stated, “Views about the running of the care home are obtained by service user questionnaires. There is always a happy atmosphere at the care home…..” During our visit we found that the information contained in the services aqaa didnot really tell us how they had evidence in place to show improvements in the overall management and monitoring of quality in the service. Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 35 As detailed throughout this report we noticed the aqaa did not give enough information to accurately show what improvements had been made to the service and some claims conflicted with the evidence found. The aqaa was found to be inadequate at the previous visit from our department and was commented on in the prebious report. The evidence during our visit showed their were still concerns about requirements that had not been actioned by the provider following our last visit 12 months ago and remain outstanding as repeated requirements. Due to the repeated concerns raised during our visit we have arranged a senior management review within our department to discuss CQC response to failings at the service. There were gaps to the aqaa regarding various dates of necessary checks on the facilities and equipment such as gas aplliance checks. Although we saw a sample of up to date maintenance checks on facilities at the service all checks should be reviewed to make sure both the provider and manager are confident that the service is safely managed with contractor visits and specialised maintenance checks. The manager has worked at the service for over 4 years and works long hours and has not been able to take a holiday for approximately a year. Working such excessive hours does not support the wellbeing of the people who use the service as this does not give the manager sufficient time to complete managerial tasks and could lead to the manager not completing her duties satisfactorily due to fatigue. The aqaa states the provider has been at the service for the past few months, 3 to 4 days a week to help support the manager. However during our visit the provider had been unable to visit the service for approximately 3 weeks for various reasons. The provider must look at what support and resources he is able to realistically provide as the manager is unable to safely and appropriately manage the service without these necessary resources. The shortfalls in the record keeping around staff recruitment checks, staff training, staffing levels, social support, care planning, risk assessments and finances indicate that the management of the home is not as affective as it needs to be to promote the welfare of the people living at Sylvan House. Various positive comments from staff enclosed in the comment cards submitted to the commission included support for the manager stating e.g. “The manager will always give you support and we can always go to the manager when we need support.” “My manager is always here to support my developments.” “Manager always gives me constructive criticism.” Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 36 “Manager will phone staff when someone calls in sick and we always get cover.” “If a problem arises we can always go to the manager for help and advice.” We could not find any recent provider reports, the last one we could see was dated for December 2008. The responsible person must make sure that all regulation 26 visits are carried out monthly and reports produced to show there are regular company checks on the standards offered within the service. These visits should help to show what actions are being taken to a lot of the areas already identified through this report. There were no details in the aqaa about whether they had an annual development plan in the policies section. The service did not have a development plan which could be developed and shared with people, staff and relatives to show what plans are taking place regarding their home and regarding feedback to any of their requests and suggestions. We did not have access to the company accounts and neither did the manager. The provider has agreed to let our department look at these financial records following our visit to the service. We have requested that the provider produces his company accounts and current budget to show how the service is being managed financially and to show evidence of the services financial viability to offer an appropriate and safe standard of service. There were gaps to the aqaa regarding basic policies and procedures . This meant that people did not have access to all necessary policies and procedures to help them do their job in the right way and this was evidenced during our visit. The staff must have access to a full list of updated policies and procedures to help them provide the right support and guidance in working at the service. Policies must include access to e.g., appropriate moving and handling procedures in line with relevant moving and handling legislation, environmental risk assessments, financial management and support of peoples money, activities and social support, staff training needs and development, infection control, care planning, induction, privacy, values of privacy,dignity and laundry procedures. etc. The accident records were examined and indicated appropriate information had been recorded and appropriate actions had been taken by the staff to help keep people safe after injury Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 37 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 1 X 3 2 X n/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 1 X X 2 2 2 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 1 X X 1 Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 38 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 OP7 Regulation 13 Requirement The service must ensure that the care home is managed and conducted to maintain the health and safety of everyone at Sylvan House. Unnecessary risks must be identified with the use of risk assessments and actions taken to eliminate those risks. REPEATED REQUIREMENT Appropriate arrangements must be made available to engage people in offering accurate activities advertised and requested which meet their needs to enhance their quality of life. REPEATED REQUIREMENT The service must have access to sufficient numbers of staff offering support with care, activities and the laundry, given the number and needs of the people who use the service, size and layout of the building. This will help to evidence they have the right numbers and DS0000064575.V375774.R01.S.doc Timescale for action 24/07/09 2. OP12 16 24/07/09 3. OP27 18 24/07/09 Sylvan House Version 5.2 Page 39 levels of staff to meet peoples needs. REPEATED REQUIREMENT 4. OP29 19 schedule 2 The service must not employ staff inclusive of volunteers to work at Sylvan house until satisfactory checks are in place. Safe checks will ensure the safety and well being of the people using the service. REPEATED REQUIREMENT 24/07/09 5. OP30 18 All staff must be suitably 24/07/09 qualified and competent and must be given the right training that is up to date to do their work so that they can always support the health and welfare of people living at Sylvan House. REPEATED REQUIREMENT Money belonging to people living 24/07/09 at the service must not be stored in any company account. All transactions must be clear and accurate with receipts kept to show how their money is managed in their best interest. This is to ensure that they are safeguarded from financial abuse and that their rights are protected. REPEATED REQUIREMENT The statement of purpose and service user guide must be updated and must be accurate and kept under review. This will make sure that everyone has enough information to make decisions about Sylvan House and are kept up to date with all aspects about the service. The provider must ensure DS0000064575.V375774.R01.S.doc 6. OP34 20 7. OP1 6 24/07/09 8. OP7 13 24/07/09 Page 40 Sylvan House Version 5.2 9 OP26 13 10 OP26 16 11 OP33 26 suitable arrangements; training, equipment and risk assessments are in place for the safe systems necessary for the moving and handling of people living at Sylvan House. This will help eliminate identified risks to people living at the service and keep them safe. The provider must make sure there are suitable actions are carried out to prevent infection and toxic conditions at the service. Actions must be taken regarding the current sediment in water tanks so that people are not put at risk. The provider must consult with the environmental health authority and make suitable arrangements for maintaining satisfactory standards of hygiene. The provider must make sure all of their requirements are carried out and provide the right kitchen equipment to ensure safe, suitable standards for the preparation and storage of food. The provider person must make sure that all regulation 26 visits are carried out monthly and reports produced. They must show that they, inspect the premises, and interview both staff and people living there and their representatives in order to form an opinion of the care provided at the service. 24/07/09 28/08/09 24/07/09 12 OP33 17 The aqaa must be resubmitted to 24/07/09 the commission. The provider must make sure that this document is kept up to date and is accurate to show what the provider is doing about improving standards in the service. DS0000064575.V375774.R01.S.doc Version 5.2 Page 41 Sylvan House 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. Refer to Standard OP12 Good Practice Recommendations A review of the activities currently available should be undertaken with people with a view to providing a greater range of activities that meet the preferences of people. Care plans must be updated with their social needs and requests. Steps should be taken to enhance the outdoor area for the people who want to use it. There must be clear financial care plans and up to date policies relating to the management of the monies held on behalf of the people who use the service. New staff should be provided with access to thorough induction, which meets the standards of Skills for Care and gives them the right support and skills to do their job. The provider and manager must ensure that there is an appropriate training budget and plan of training provided for all staff in order to carry out their roles appropriately both with care, social needs and with the laundry. An audit of the training needs of staff must be identified to give a clear and accurate training plan, so the manager can plan and identify the right training for staff. There must be evidence in place to show why staffing levels were reduced following our last visit in the afternoons from 3 staff to just 2 care staff on duty. Staffing levels should also be reviewed regarding the necessary resources and hours needed for developing and providing activities and for the ongoing laundry of clothes and linen. They must assess the dependencies of the people at the service and how they measure the ongoing staffing levels to meet the needs of the people living there. Accurate information and clear records must be accessible and available at the service to show how many people live there. This is necessary for the health and safety of the building and it is necessary for the ongoing reviews needed in assessing the staffing levels to support people. DS0000064575.V375774.R01.S.doc Version 5.2 Page 42 2. 3. OP35 OP27 4. OP27 Sylvan House 5. OP33 The provider must review staffs opinions and look at what actions can be taken to improve the moral of the current work force to ensure a stable staff team continues to work at the service. There should be a lot of development and consultation with the people who live at the service and their relatives around important issues affecting Sylvan house. A development plan should be produced and shared with people, staff and relatives to show what plans are taking place regarding their home and regarding feedback to any of their requests and suggestions. People should be given feedback to the company questionnaire they completed and told what the provider will do with their comments and suggestions. The staff must have access to a full list of updated policies and procedures to help them provide the right support and guidance in working at the service. Policies must include access to e.g., appropriate moving and handling procedures in line with relevant moving and handling legislation, environmental risk assessments, financial management and support of peoples money, activities and social support, staff training needs and development, infection control and laundry procedures. 6 OP33 7 OP38 Sylvan House DS0000064575.V375774.R01.S.doc Version 5.2 Page 43 Care Quality Commission North West Region Citygate Gallowgate Newcatle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northwest@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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