CARE HOMES FOR OLDER PEOPLE
The Sycamores Norton Road Wakefield WF1 3PB Lead Inspector
Tony Railton Key Unannounced Inspection 23rd January 2008 08:30 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 The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Sycamores Address Norton Road Wakefield WF1 3PB 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) 01924 379994 sycamores@tri-care.co.uk Tri-Care Ltd Post Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st May 2006 Brief Description of the Service: The Sycamores provides personal care and accommodation for up to 40 older people. The home is built on two levels with single en-suite accommodation and provides shared lounges and dining rooms. There is a passenger lift and assisted bathing for those who require them. The grounds and gardens to the home are well presented and accessible. There is a large garden to the front with trees and flowering shrubs and garden furniture for the use of people using the service. There is car parking to the front of the building and the home is easily accessible to local shops, church and public houses. On the 23rd January 2008 the manager said that the fees ranged from £380.35 to £525.00 per week. Further information about the services provided can be obtained and the role of the CSCI can be obtained by contacting the home or e-mailing sycamores@tricare.co.uk The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This service has been given a Two Star rating, which means that the people using the service experience good quality outcomes.
The visit to the home commenced at 08.30 and ended at 13.00. The inspector arrived early to observed the morning routines of the home. During this visit there was the opportunity to speak to most people using the service and three visiting relatives. There was also the opportunity to speak to the acting manager, all the care staff, kitchen staff and domestic. The files of six people using the service were seen and included assessments care plans, reviews, medical and daily records. The files of six staff were also seen and included references, police and P.O.V.A (Protection of Vulnerable Adults List) checks, training and supervision records. A tour of the home was undertaken and four peoples medicines and three peoples finances were checked. Other information considered included the service history, record of complaints and the minutes of Safeguarding Referrals. The menus, staff rota and record of activities were also considered. This was a very positive unannounced visit and the inspector would like to thank the people using the service, the acting manager and her staff team for their co-operation and patience throughout the visit. What the service does well:
People enjoy living in a home that is well decorated, well maintained, comfortable and safe. One person using the service said that the home is “lovely” and that they have “everything they need” To make sure the home can meet people’s needs these are assessed before they are offered a service. Peoples care needs are set out in their care plans that are reviewed regularly to make sure that they get the support and care they need and require. People have a say in what happens to them and they are assisted and encouraged to make decisions for themselves. There is a range of organised activities for people to choose from. One visiting relative said the meals always look good
The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 6 and smell “wonderful”. One person said that they enjoy the meals and have a choice of menu. The chef said that all the meals are freshly cooked and people can chose their own menu. People have a say in what happens to them and the opportunity to comment on the running of the home. People are protected by the way medicines are dealt with and staff are trained in how to do this properly and safely. People are also protected by the way staff are recruited and selected as staff records show that references and police and POVA (Protection of Vulnerable Adult List) checks are taken up before they are employed. One person using the service said that care staff are “angels”, another said staff are “wonderful”. Care staff were observed throughout the visit treating people with dignity and respecting their wishes, and peoples needs were being met in a relaxed and unhurried manner. What has improved since the last inspection? What they could do better:
People using the service and their relatives are involved with their assessments and reviewing their plans of care, however, they do not sign to indicate their involvement or to show they agree with their care plans. Staff were observed asking people what they wanted to do, where they wanted to sit and were offered a choice of menu. However, the daily records do not contain descriptive words to reflect and show peoples choices and preferences. People are supported and encouraged to make decisions about how they live their day to day lives, however, the daily records do not contain descriptive words to reflect and show any decisions people make about their lives. The law states that the home must have a registered manager the inspector recommends that an application to register is submitted as soon as is practicable.
The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 7 People using the service and their relatives are asked their opinion about the quality of the services provided. However, the surveys and the information on them are collated centrally and there was no report or surveys to look at to see what they said. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit. To make sure the home can meet people’s needs these are assessed before they are offered a service. The home does not provide specialist intermediate care or rehabilitation services. EVIDENCE: A sample of six assessments of people using the service shows that their individual care needs are assessed before they are offered a service. The acting manager confirmed this and said that they go to visit people to check and see if the home can meet their personal and healthcare needs. The acting manager confirmed that the home does not provide a specialist intermediate service for the sole purpose of rehabilitation. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit. People’s health and personal care needs are met and they are protected by the way medicines are dealt with. EVIDENCE: People using the service said that they feel their care needs are met. One said that they have everything they needed. Another said that the care staff is “angels” and three visiting relatives said that the “home is very good” and that there relatives “want for nothing” and have “everything they need”. Six records of people using the service show that their needs are assessed and that care is planned and reviewed regularly. The reviews and discussion with the acting manager confirmed this. Throughout the visit people were observed being treated with dignity and having their wishes respected. However, the daily records did not contain descriptive words to reflect and show peoples choices and preferences made on a day-to-day basis.
The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 11 The acting manager said that people and their relatives are fully involved in the assessment and care planning process. People using the service and their relatives confirmed this. However, most of the reviews seen did not contain the signature of the person or their relatives to show their involvement or to say that they agree with the care provided. People using the service are protected by the way medicines are dealt with as a sample of four peoples medicines were checked and found to be correct. The staff training records also show that people giving medicines have been trained to do so safely. Discussion with care staff found that they have a good understanding of the care and health needs of older people. Three visiting relatives said that the home provides “good quality care”. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit. People and their relatives find the lifestyle experienced matches their expectations and they are offered a varied and balanced diet. EVIDENCE: People were observed enjoying their breakfast in relaxed and pleasant environment. People were also observed being asked what they would like to eat and having their wishes respected. The inspector was impressed with the background knowledge held by the staff team of people’s likes and dislikes with regard to menu. The dignity afforded to people using the service by care staff was also impressive; as was the relaxed and unhurried manner they performed their duties. One person said that the meals are “great”; another said the food is “wonderful”. One relative said the meals “always look good” and “smell great”. The chef said that the meals are all freshly cooked and that people have a choice of menu. The menu choice lists and food order forms confirmed this. The daily records and record of activities show that people have the opportunity to join in regular activities if they want to. People throughout the
The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 13 visit were observed having their wishes respected and making decisions about how they live their daily lives. However, the daily records do not contain descriptive words to reflect and show people’s choices, preferences and any decisions they make about how they live their lives. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit. People using the service and their relatives know that their complaints will be listened to and acted upon and that they are protected from self harm and abuse. EVIDENCE: The people using the service said that they have never had any reason to complain. One said that their “room is wonderful”, the meals are “wonderful and the staff are “angels”. Three visiting relatives said that they have never had a reason to complain about the home. One relative went on to say that if there are any minor issues they tell the staff and “these are dealt with there and then”. The acting manager and area manager said that there has only been one complaint since the previous visit. The record of complaint confirmed that a complaint about a bedroom carpet that needed cleaning and was dealt with promptly by the home. The minutes of the residents and relatives meetings show that people have a say and the opportunity to comment on the running of the home and on the services provided. People are protected and safeguarded against abuse, as the acting manager said that all staff receive POVA (Protection of Vulnerable Adult) training. Discussion with care staff and the staff training records confirmed this.
The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 15 The minutes of three Safeguarding referrals show that these are dealt with properly and peoples best interests are safeguarded by the policies and practices adopted by the home. One recent Safeguarding referral resulted in the home adopting a ‘key pad’ security lock on the main entrance to make sure that people remain safe. Three visiting relatives thought that the keypad lock on the front door was a good idea as it improved the security of the building and safety of residents. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit. People live in a well decorated well, maintained environment that is comfortable, homely and safe. EVIDENCE: A tour of the home found it to be decorated and maintained to a high standard and all parts of the home are clean and free of any unpleasant odours. The dining rooms and lounges were particularly pleasant and presented well with tables well set and decorated with flowers. People using the service said that the home is very good. One said that they “like” their bedroom and have “everything they need”. Another said its “home from home” and another that they are “very comfortable indeed”. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 17 One visiting relative said that they are very pleased with the way the home looks and it’s like a “five staff hotel”. Another relative said that they “would like to move in”. The manager said to keep people safe regular health and safety checks are carried out. The maintenance records confirmed this. The Area manager also said that the environment forms part of the monthly providers audit report to make sure that live in a well maintained and safe home. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit. Trained and qualified staff meet peoples personal and healthcare needs and they are protected by the way staff are recruited and selected. EVIDENCE: People are protected by the way staff are selected and recruited as a sample of five staff records show that references, Police and POVA (Protection of Vulnerable Adults List) checks are taken up before staff are employed. These records also show that peoples care needs are met by staff that have NVQ (Notional Vocational Qualification) at Level 2 and above. People are in safe hands as training records show that staff are trained in First Aid, Moving and Handling, Food Hygiene, Infection Control, Health and Safety and COSHH (Control of Substances Hazardous to Health. The acting manager said that there are enough staff planned to be on duty to meet the needs of people using the service. The duty rota confirmed this and on the day of the visit there were enough staff observed on duty to meet the needs of people using the service in a relaxed and unhurried manner. Discussion with the care staff found that they have a good understanding of the needs of people using the service. One said that they feel supported in the work that they do. Another said that they “love” working in the home.
The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 19 The inspector was impressed by the positive attitude of care staff towards people using the service and the positive relationships observed between staff and those using the service. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including this visit. People live in a well managed home that is run in their best interests and there they have a say in what happens to them. People’s health, safety and wellbeing is also promoted and protected. EVIDENCE: The care management systems and in particular peoples assessments, care plans, reviews, medical and daily records are good and reflect and show that peoples care needs are met. The Staff management systems and in particular recruitment and selection, training and supervision records show that people are safe and are cared for by staff that are trained and qualified.
The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 21 The maintenance records and in particular health and safety assessments, providers monthly reports, fire and emergency equipment checks show that people live in a safe environment that is well maintained and well managed. Observation of people using the service shows that they are treated with dignity and their wishes are respected. The minutes of the residents and relatives meetings show that they have the opportunity to comment on and have a say in the running of the home. The acting manager and area manager said as part of quality assurance monitoring, the views of people using the service and their relatives is sought on the quality of care provided. However, no surveys or report was available for inspection. The area manager said that the completed surveys are collated centrally and a report provided. Peoples financial interests are safeguarded and promoted as a sample of three people’s monies were checked and found to be correctly administered. The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Sycamores DS0000035670.V358469.R01.S.doc Version 5.2 Page 23 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 Refer to Standard OP7 Good Practice Recommendations The daily records would benefit from an increase in the use of descriptive words to reflect and show peoples choices and preferences they express on a day -to -day basis. Descriptive words should be used in the daily records to reflect and show any decisions made by people using the service regarding how they live their daily lives. The law says the home should have a registered manager. The acting manager should make an application to register as soon as is practicable. The service providers should obtain a copy of the Annual Quality Assurance Assessment and complete and return it to the CSCI as soon as is practicable. The information gathered through people’s quality assurance surveys should be collated and a report provided that reflects the comments and outcomes for people using the service.
DS0000035670.V358469.R01.S.doc Version 5.2 Page 24 2 3 4 5 OP14 OP33 OP33 OP33 The Sycamores Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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