Care Home: Sebright House

What the care home does well The atmosphere at Sebright House is relaxed and friendly, staff were observed to have a good relationship with the residents and were patient and supportive when delivering care. Staff were seen talking to residents and completing activities with them at various times throughout the inspection. Both residents and visitors appeared at ease and gave positive feedback regarding management and staff.One visitor said they had been to ten other homes before this one and they knew when they walked in the door this was the home for their relative. Two visitors praised the staff and said they were very happy with the care their relatives were receiving. One said that their relative was "in the best place". The manager is dedicated to provide high quality care for the residents at Sebright house. She takes time to research information and undertake training specific to the needs of people with dementia to ensure they receive the best care the home can provide. Comment cards from relatives show positive responses about the care and services provided. One states the home "provide a wonderfully supportive environment in which frail, dementia patients are cared for meeting their emotional and physical needs in an amazing way". A comment card from another relative states "they provide and enable people with dementia the opportunity to have meaningful and good lives" and also "the atmosphere in the home is warm and friendly, with good interaction plainly evident between staff, residents and relatives". The environment generally is well maintained and has been adapted in many areas to assist those residents with dementia in orientating around the home. This includes using different colours around the home so residents can identify where they are and signage which residents can identify with on the doors to their bedrooms. Residents receive a detailed and thorough assessment prior to their admission to the home to ensure all of their needs are identified and it is clear they can be met by the home. The manager has set up advice sessions for relatives in regards to dementia to help in providing them with information about this condition and how they can help to support their relative. The majority of staff have been trained to NVQ III in Care and all staff have completed training in dementia care to help support the residents effectively and safely. This home have the benefit of a weekly visit from a GP to help support the residents with medical needs. Various therapies have been introduced to help residents experience a positive experience in the home. This includes doll therapy, sensory aids and hand massages. What has improved since the last inspection? What the care home could do better: The bathrooms in the home look uninviting and are in need of refurbishment to help make bathing a more pleasant experience for the residents. The care plans need to be reviewed to make them more user friendly so that staff can easily identify care needs of residents and what is required of them without having to read the majority of information in the care plan. They also need to include more specific information in regard to the management of diabetes. Duty rotas need to be reviewed so that it is consistently clear what hours/shifts each member of staff is working and in what capacity. There must be a clear protocol in place in regards to staff signing for medications that are prescribed for "one or two" tablets or capsules to be given. This is to ensure Medication Administration Records (MARs) are clear in showing what the resident has taken. Some of the record keeping in the home requires review this includes financial records, records of food provided to residents, fridge and freezer temperatures and relating to electrical wiring in the home. This is to ensure there is sufficient evidence to show these matters are being addressed effectively consistently. CARE HOMES FOR OLDER PEOPLE Sebright House 10 - 12 Leam Terrace Leamington Spa Warwickshire CV31 1BB Lead Inspector Sandra Wade Draft - Unannounced Inspection 20 November 2007 09.05a 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 Sebright House DS0000041396.V342529.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. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sebright House Address 10 - 12 Leam Terrace Leamington Spa Warwickshire CV31 1BB 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) 01926 431141 01926 431326 Interhaze Ltd Mrs Johanne Catherine Shuker Care Home 40 Category(ies) of Dementia (12), Dementia - over 65 years of age registration, with number (40) of places Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Sebright House may admit up to 40 older people with dementia, 12 of whom can be people with dementia aged 50 years and above. 9th August 2006 Date of last inspection Brief Description of the Service: Sebright House is situated in Leam Terrace, a short walk from the town centre shopping area and picturesque gardens alongside the river. Car parking is on the roadside but this is time limited on one side of the road. Sebright House care home is registered to provide specialist Dementia care to people with dementia who also need nursing care. Sebright House can accommodate up to 40 residents, in single and double room accommodation. There are 33 bedrooms, which are, situated over three floors, these include seven shared rooms and 26 single rooms. All floors can be accessed by a shaft lift. The majority of the bedrooms have an en-suite facility but there is one shared room and five single bedrooms that do not. These rooms have washhand basins and there are toilets close by. There are three lounges and one of these is situated in a conservatory overlooking the garden. This area is also used as a dining area but there is also a separate dining room. Registered General Nurses and carers, many of which, have attained National Vocational Qualifications at levels 2 and 3, staff the home. The service provision includes full board and 24 hour nursing care. The Resident Guide leaflet viewed on 20 November 2007 states that the fees range from £475 plus the nurse-banding fee each week. Additional charges are made for private chiropody, dentistry, opticians, physiotherapy, personal toiletries and hairdressing. The Statement of Purpose document indicates extra charges are made for staff escorts, which are indicated as £25.00. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place from 9.05am to 5.40pm. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. Upon the receipt of this a number of questionnaires were sent out to residents and their families to ask their views about the home. Five resident comment cards were returned but due to the dementia client group, only three of these had been completed and five relative comment cards were received. Information contained within these plus the AQAA are detailed within this report where appropriate. Three people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Resident Guide, Statement of Purpose, staff duty rotas, social activity records, kitchen records, accident records, health and safety records and medication records. Some of the documentation was looked at in the lounge, this enabled the inspector to see residents in their usual surroundings and see the interaction between staff and residents. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: The atmosphere at Sebright House is relaxed and friendly, staff were observed to have a good relationship with the residents and were patient and supportive when delivering care. Staff were seen talking to residents and completing activities with them at various times throughout the inspection. Both residents and visitors appeared at ease and gave positive feedback regarding management and staff. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 6 One visitor said they had been to ten other homes before this one and they knew when they walked in the door this was the home for their relative. Two visitors praised the staff and said they were very happy with the care their relatives were receiving. One said that their relative was “in the best place”. The manager is dedicated to provide high quality care for the residents at Sebright house. She takes time to research information and undertake training specific to the needs of people with dementia to ensure they receive the best care the home can provide. Comment cards from relatives show positive responses about the care and services provided. One states the home “provide a wonderfully supportive environment in which frail, dementia patients are cared for meeting their emotional and physical needs in an amazing way”. A comment card from another relative states “they provide and enable people with dementia the opportunity to have meaningful and good lives” and also “the atmosphere in the home is warm and friendly, with good interaction plainly evident between staff, residents and relatives”. The environment generally is well maintained and has been adapted in many areas to assist those residents with dementia in orientating around the home. This includes using different colours around the home so residents can identify where they are and signage which residents can identify with on the doors to their bedrooms. Residents receive a detailed and thorough assessment prior to their admission to the home to ensure all of their needs are identified and it is clear they can be met by the home. The manager has set up advice sessions for relatives in regards to dementia to help in providing them with information about this condition and how they can help to support their relative. The majority of staff have been trained to NVQ III in Care and all staff have completed training in dementia care to help support the residents effectively and safely. This home have the benefit of a weekly visit from a GP to help support the residents with medical needs. Various therapies have been introduced to help residents experience a positive experience in the home. This includes doll therapy, sensory aids and hand massages. What has improved since the last inspection? Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 7 Staff training has continued to ensure staff are able to provide effective care and services to the residents. Requirements made at the last inspection relating to care planning, medication and moving and handling training have been addressed. New chairs have been purchased for the communal areas and there have been improvements made to the décor including new carpets and soft furnishings to benefit the residents. Arrangements were made for the manager to see all relatives to discuss the care of their relative in the home to ensure their needs are being met to a satisfactory standard. The manager is currently working on compiling memory boards and memory boxes to help bring past happy experiences back into the memories of the residents in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 9 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 Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 10 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): Standards 1 and 3 were assessed. Standard 6 is not applicable. Quality in this outcome area is good. Residents and relatives receive sufficient information to make an informed decision about the home and all residents are assessed prior to their admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Residents Guide leaflet, which details information regarding personal, nursing and social care provided by the home. The resident guide leaflet gives details of the fees and any extra charges that may be incurred. There is also information about entertainment, mealtimes, complaints and the aims and objectives of the home. This leaflet has been printed in other languages including Polish to help people using or accessing the service to know what services and care provision is provided. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 11 The Statement of Purpose is a more detailed document and is provided with a Statement of the Terms and Conditions of the home. The manager confirmed this is also given to prospective residents. This document details information on the accommodation, staffing arrangements, admission criteria, the operation of the care home, religious needs, visiting, fire precautions etc to help inform the relatives in making a decision on whether to choose the home for their relative. The manager confirmed that she undertakes assessments prior to any of the residents being admitted to the home. Initially an enquiry form is completed and the manager seeks information from the social worker (if applicable) and obtains copies of any care plans or reviews carried out. This information helps to inform the assessment process carried out by the manager. The assessment undertaken by the manager can take place in the residents own home or in the care home. A full and detailed assessment is undertaken and recorded on a standardised document to ensure all of the relevant information is obtained. Discussions are held with those present (either relatives or hospital staff) to obtain further background information. Pre admission assessments were seen within care plan files viewed and it was evident that full and detailed information had been obtained to help devise suitable care plans. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is good. Care plans are in place for each resident and residents receive a good standard of care to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were reviewed for residents in the home. All files contained detailed information about their care needs and how these should be met. This included specific information on their dementia care needs. It was evident from discussion with the manager that she is very well informed in regards to the care needs of people with dementia and that the care needs of residents are being well managed. The Annual Quality Assurance Assessment (AQAA) completed by the manager demonstrates that she spends time researching information relevant to dementia care as well as other areas Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 13 to ensure care practices are updated where appropriate to the benefit to the residents. It was observed that various therapeutic practices are in place to help the residents enjoy a positive and calming experience of care within the home. This includes doll therapy and sensory light therapy. One resident had a sheet of twinkling lights above the bed which staff put on at certain times of day to stimulate the sensory needs of the resident and to give a calming effect. Different types of music is played in different lounges during the day and it was observed throughout the inspection that there was a calm and relaxed atmosphere throughout the home despite many of the residents in the home having the potential for challenging behaviour. Of the five comment cards received by us from relatives, three out of five stated the home “usually” meets the needs of their relative and two confirmed they “always” do. One person stated they were “very happy with Sebright House” and stated that any health issues “have been promptly raised and dealt with”. One person stated that their relative had behaviour problems and it was taking time for staff to adapt to meet these but stated “they are gradually devising strategies for meeting X’s daily needs”. Comment cards contained a question “Does the care home give the support or agreed care to your relative/friend that you would expect or agreed”? Two responded “always” with one commenting “X is being cared for as well as could be expected”, two responded “usually” and one stated “sometimes”. Each care file contains a care plan on how each resident’s dementia is to be managed. Where possible the manager has attempted to obtain background information and old photographs of the residents to enable life history storybooks to be compiled. This helps staff to understand the needs of the residents and to better support them when providing care. The manager advised that all residents are weighed monthly and if a weight loss is identified they are then weighed weekly. Care plan files viewed confirmed this. Where residents had been identified to have poor nutrition, food and fluid charts had been commenced to ensure they were eating and drinking sufficiently to maintain their health. In one care plan file the nutrition charts had not been completed in sufficient detail to be sure what the resident had eaten. For example it said “soup, supper, pudding” and indicated all of the soup had been taken, none of the pudding and half of the supper but it was not clear what the “supper” was. All care plan files viewed showed that the weight of residents was stable and none of the residents seen looked unacceptably thin. Staff are required on a daily basis to record any signs of well or ill-being so that appropriate actions can then be taken to address this. Those records seen Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 14 showed that all residents showed signs of wellbeing. We spent a period of time observing residents in the home and it was evident that all residents showed signs of wellbeing. Staff were attentive to all residents regardless of their level of dependency. A risk assessment had been completed for a resident identified to have a history of pressure ulcers. This showed that the person was at high risk. The manager reported that staff are required to undertake regular skin checks and it was evident from the daily records for this person that this was being done. A recent daily record showed that the person had “redness” on their left side indicating that staff are carrying out the checks although this information had not been transferred onto the body chart to make it easier for staff to locate when monitoring the skin. Care plans were in place for managing mobility and the equipment needed to manage this safely was indicated in the care plans such as hoists, wheelchairs and handling belts etc. Specialist equipment for pressure area care was also recorded including pressure cushions and mattresses. Files viewed for those residents with diabetes contained care plans stating the frequency that blood sugar levels should be monitored. Records in place showed that this was being done. It was not evident that the accepted range of high and low readings had been established for each resident with this condition so that it was clear to staff at what point the GP should be contacted. Care plans did not indicate the symptoms associated with high/low blood sugar levels so that it would be clear to all staff how to identify these conditions and take appropriate action. As care plans are pre-printed and staff delete sections not relevant, the care plans can become less person centred and sometimes difficult to follow. For example in one care plan for “at risk of weight loss” it stated in the actions “cut up/and or assistance with feeding” – it was not clear which of these was applicable. Care plans for communication frequently indicated for flash cards to be used as a form of communication with residents. It was not evident during the inspection that these were required for the residents where it was indicated these could be used. Two care plans viewed for challenging behaviour stated that this behaviour was being displayed on a daily basis but on reading the daily records it was evident that this was not the case. One of the care plans had been evaluated on 14.11.07 and no changes had been identified. It was noted that care plan reviews which are done monthly stated repeatedly “complete review of care plans done – all remains the same”. It was not evident that staff are reviewing each care need and the staff intervention individually to show any changes in support required. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 15 Care records showed that residents are accessing specialist services such as chiropody, GPs, opticians and dentists when required. This home has the benefit of a weekly visit from the GP to support any medical needs of the residents. A review of medication was undertaken. Records were seen to show that the manager is regularly auditing medication to ensure this is being managed effectively. All records and medications checked were found to be accurate with the exception of one record relating to the use of Zopiclone. 56 tablets had been received and staff had signed to say that 35 had been given which should have left a total of 21 but there were 23 tablets left. This suggests two tablets had been signed for but not given. It was identified that this could be due to this medication being prescribed for one or two to be given and staff not indicating how many had been given on the Medication Administration Record (MAR). This issue was identified at the previous inspection for action. The home must agree a protocol for medications where one or two tablets/capsules are prescribed so that it is clear on the MAR what staff are signing for. A controlled drugs register is in place and medications were being stored appropriately. Controlled drugs checked were found to be correct in accordance with the records in place. No concerns were identified in regard to the privacy and dignity of the residents. A double room viewed had a dividing curtain to maintain the privacy of the residents sharing this room. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 16 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): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is good. Residents have access to various social activities each day to provide stimulation and help satisfy their social care needs. Residents also are able to make choices about their daily life in the home to help maintain their independence and they enjoy homemade cooked meals and snacks during the day. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were seen to have an excellent relationship with the residents. Throughout the day staff spent one to one time with residents, chatting to them, providing a manicure, looking at pictures or playing games such as patting the balloon around the room. A comment card received by us from a relative states that the home “provide a wonderfully supportive environment in which frail, dementia patients are cared for meeting their emotional and physical needs in an amazing way”. A comment care from another relative states “they provide and enable people with dementia the opportunity to have meaningful and good lives”, “the atmosphere in the home is warm and friendly, with good interaction plainly evident between staff, residents and relatives”. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 17 There is a monthly activity timetable which is flexible and which states it is only a guide. This indicates activities such as make up and nails, story reading, brass polishing, painting/colouring, listening to life histories of others, walks in the garden and music. On the day of inspection a selection of the residents were doing potato prints in the conservatory and writing Christmas wishes on paper baubles for the Christmas tree. A member of staff who undertakes activities with the residents showed them paintings done the day before by other residents. Some residents were happy to sit at the table and just watch what was going on. The manager said that they have three volunteers who come into the home to help with social activities and stimulation. This includes reading poetry, hand massages and one to one talks with residents. The home celebrates individual birthdays with a cake and staff sing happy birthday. Events are also held in the home throughout the year for Halloween, Guy Fawkes, and Christmas etc. The manager said that there are portable hearing loops available in the home but residents were reluctant to wear hearing aids so these were rarely needed. There is a selection of music available and the manager said that provision had been made for talking books/newspapers for a resident with partial sight. Religious needs are considered upon admission and the manager attempts to ensure these can be met as far as possible. The manager said that Holy Communion is held in the home once a month and some residents are taken to church. Residents are given as many choices as possible regarding routines of daily living. Usual times for getting up and going to bed are obtained from relatives and details are recorded in care files. Records also show that residents are able to choose whether they prefer to receive care from a male or female carer and can choose whether to have a bath or shower. Discussions with staff confirmed that mealtimes are flexible to meet individual preferences. At lunchtime residents were given the choice about where they would like to sit and were offered a choice of two meals. Staff were observed to take the two meals to show residents so that they could see what the meals looked like to help them make a choice. On the day of inspection the main meals were fish cakes with parsley sauce or sausage casserole with vegetables. Both meals were of a good size and looked appetising. Throughout the day residents were seen to have drinks from the trolley and biscuits and fresh fruit. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 18 A comment card from a relative states “the food is outstandingly good and well presented”. At supper time there is usually soup on the menu as well as a hot choice snack meal such as jacket potatoes, chicken nuggets, scrambled egg, hot dogs etc. Residents were seen to enjoy their food and confirmed this to staff when asked if they enjoyed their meal. The menus are varied and included a good range of choices for breakfast, lunch and supper. It is evident that they have been compiled using the guidance from the National Food Standards Agency to ensure residents receive a varied and wholesome diet. Menus indicated that a snack of jam sandwiches/biscuits and a hot drink is provided in the evening and the manager said that many of the residents enjoyed this evening snack. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18 were assessed. Quality in this outcome area is good. Procedures are in place to ensure residents and their representatives know how to make a complaint and systems are in place to help protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is in place and this is on display in the home. There is also a pictorial complaints procedure to help those residents with dementia understand the process for raising a concern. The complaints process is also detailed in the Service Users Guide and a more detailed procedure in the Statement of Purpose. The complaints procedure refers complainants to the manager, operations manager or proprietor but does not list named contacts; telephone numbers or contact addresses to help complainants easily contact these people. Some of the procedures around the home contained our old address and need to be updated. The home has not received any complaints for the last two years but do have systems in place to record any complaints that may be received. We have not received any complaints in relation to this home. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 20 Comment cards received from five relatives showed that four of them knew how to make a complaint if needed and one did not. Comment cards completed by three residents showed that two people knew how to make a complaint and one did not. Relatives seen during the visit were very positive in their comments about the home. A comment card received by us from one relative was concerned that items such as glasses had been reported as missing and had not been found. The manager said she was not aware of this. The manager said that all staff in the home have received training on the protection of vulnerable adults (POVA) and training records confirmed this. The Annual Quality Assurance Assessment document confirms there are policies and procedures in place in regard to the protection of adults. It was observed during the inspection that there are notices on the wall in the staff areas confirming the types of abuse and the reporting system that staff should follow should this be identified or reported to them. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 21 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): Standards 19, 21, and 26 were assessed. Quality in this outcome area is good. Residents live in a well maintained environment which is subject to ongoing improvement and maintenance. The home presents as a comfortable and safe environment for those living there and visiting. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the Home was undertaken. A number of bedrooms and all communal areas were reviewed at this inspection. All furnishings seen were in a good state of repair. No unpleasant odours were noted and all areas were clean and hygienic. Residents appeared at ease in their surroundings and wandered freely around the Home. The manager has taken actions to introduce colour zoned areas within the home to help residents recognise where they are and to more easily identify bathrooms and toilets. Bathroom doors are painted blue and have pictorial and written signage and toilet doors, en-suite toilet doors Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 22 are painted yellow. Work is still continuing on colour zoning corridor areas where bedrooms are located. Bedrooms seen had been personalised with pictures and ornaments and specialist equipment required such as pressure relieving mattresses, wheelchairs and bed rails were in use for those residents who required them. It was found that none of the rooms viewed had towels available in the ensuites or bedrooms. The manager confirmed that there were sufficient supplies of these to exchange clean towels for dirty ones when they are removed. The manager agreed to address this. In one bedroom there was no toilet seat, the manager said it was most likely this was on the maintenance list to be addressed. Communal facilities consist of a conservatory, a dining room and two lounges, all were clean and in a good state of repair. Hot water tested in residents’ rooms was found to be at a safe temperature and radiators touched were not too hot to cause a burn risk to residents. Bathrooms and shower rooms were viewed and it was evident that the décor of some of these is stark and clinical as opposed to giving a welcoming and homely feel. This is despite the best efforts of staff to make use of transfers to try and improve the décor and make them look more welcoming. Baths have bath chairs as opposed to having a “Parker” type bath, which would be easier for residents to access as well as make the delivery of personal care a more pleasant experience for them when being assisted by staff. In one bathroom the paint was chipped on the bath chair and floor and the bath was stained. There was black and yellow sticky tape down the side of the bath. In another bathroom it was noted that the bath chair was being secured by “rip ties” which would not be comfortable or hygienic for the resident sitting on these. The manager advised that the refurbishment of the bathrooms was on the list to be addressed but it was not clear how quickly this would be undertaken. There is an attractive garden with patio areas and the manager explained that they have plans to introduce a sensory garden. There is a shed in the garden that has been set up as a beach hut. Residents are able to identify with the items in the shed to remind them of holidays and stimulate their senses of previous holidays they may have had. There are three dedicated laundry rooms for washing, drying and ironing to help maintain good infection control procedures. There are two washing machines and two driers and there are specified baskets available for dirty and clean washing. It was noted that some of these baskets were open-weave Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 23 type baskets and some were broken. This type of basket is hard to clean to maintain good hygiene practices. The manager agreed to address this. Staff were observed wearing disposable gloves and aprons whilst providing personal care to residents and also when dealing with the laundry to maintain infection control procedures. The kitchen area was on the whole clean but the cooker was noted to be in need of a deep clean. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 24 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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is good. There are sufficient numbers of trained staff to meet the needs of the residents. The recruitment policy and procedure ensures that residents are supported and protected from harm by the people caring for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the Home was adequately staffed with qualified registered general nurses as well as staff from overseas undertaking adaptation training and care staff. The Annual Quality Assurance Assessment (AQAA) completed by the manager states that the home has a ratio of one carer to every four residents. On the day of inspection there were 35 residents in the home. The manager said that she aims to have 9 carers (including nurses) available during the morning, eight in the afternoon and four or five at night. Duty rotas seen showed that on some days there was one nurse on duty during the day and on others there were two. On night duty sometimes there are two nurses on duty and sometimes there is one. The manager works in a supernumerary capacity. Duty rotas did not consistently demonstrate the Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 25 hours the manager is working in the home to demonstrate there are sufficient management hours being provided. This issue was raised at the previous inspection and must be addressed. In terms of carers on duty, duty rotas showed that for the week commencing 12 November there were mostly seven or eight staff on duty (including nursing staff) to support the needs of the residents. Other duty rotas seen showed similar numbers with sometimes nine staff being available. It was not evident that all information relating to staff available in being recorded on the duty rotas. The rota for week commencing 5 November showed that between three and six staff on duty during the day. The manager advised that there is other records maintained of staff on duty in the home. It was advised that duty rotas are accurately maintained of all staff working in the home. Duty rotas also need to consistently show staff designations and the hours of the shifts worked so that it is clear there are sufficient numbers of both ancillary staff and care/nursing staff. On night duty there were mostly four staff on duty but sometimes there were three. During the inspection it was evident that there were sufficient staff available to care for the residents. Staff were very attentive and supportive towards residents and also very patient when delivering care. Of the five comment cards received from relatives, all of them responded that the home “usually” had care staff with the right skills and experience to look after people properly. One commented, “The carers are very good, and friendly, always on hand to help”. Another stated, “Senior care staff are experienced and very caring people with good skills and knowledge of dementia. The manager undertakes regular training of staff to ensure a continuing high level of skills and understanding of dementia within the home which is apparent”. Another comment card states “very well staffed in each of the three sitting areas there is always a member of staff”. There are specific staff employed to do the laundry and duty rotas showed that sometimes there are two staff to do this and sometimes there is one. At the weekend on two of the rotas, no laundry staff are indicated. The manager advised that one of the laundry staff had recently retired and they were in the process of trying to recruit to this post. In the meantime domestic staff and sometimes care staff were helping out with laundry duties. It is not clear from duty rotas which staff are covering the laundry duties at weekends, this needs to be addressed. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 26 A new cook has recently commenced employment at the home and duty rotas show there is four domestic staff that clean the home. On some days there are four domestic staff on duty and on others there are two or three. A review of three staff files was undertaken to confirm recruitment practices carried out. It was evident that new staff employed had two written references and had completed an application form indicating their past employment and education as required. Action had been taken to apply for Protection of Vulnerable Adult (POVA) checks before staff were allowed to work in the home to ensure they were safe to work with the residents. It was noted that one of the dates of the POVA checks was a day after the member of staff had commenced work in the home. The manager explained this was due to the same check having to be requested twice as the first check had been deleted from the homes records. It was explained that there must be evidence of all checks being in place before staff are allowed to work in the home. This is to ensure residents are fully safeguarded by the homes recruitment procedures. Criminal Record Bureau checks were also available although these did not consistently show the company name or the name of the home. The manager explained that they used an “umbrella” company and this was how the CRB checks had been received. The home must ensure that it is made clear to the umbrella company that either the company name or home name is clearly indicated on the CRB check so that it is clear the home or company has instigated the criminal records check. Staff training is provided on an ongoing basis to ensure staff are appropriately and sufficiently trained to care for the residents. The induction training incorporates the “Skills for Care Council Common Induction Standards”. This training is completed over a number of weeks and allows staff to build up their competencies to be able to care for residents safely. The Home has in excess of 50 of care staff qualified at National Vocational Qualification (NVQ) level II in care and easily meets this target. The majority of the staff have completed the higher level of NVQ III and the home is to be commended for this. The manager has undertaken to ensure all staff also complete accredited dementia care training and the training schedule for the home shows that all staff have completed this training. The training schedule also shows that staff access statutory training such as moving and handling, fire safety and food hygiene etc. It was clear that all staff had done moving and handling training and fire training but it was not clear from the schedule that all staff have completed food hygiene training. This may be due to some staff having completed this in previous years. The Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 27 Annual Quality Assurance Assessment (AQAA) forwarded by the manager states that all staff who handle food have completed this training. It is advised that this is followed up accordingly so that the schedule shows dates when this was last completed to demonstrate all staff are suitably trained in this area as appropriate. Other training on the schedule includes first aid, health and safety, protection of vulnerable adults, Resuscitation and wound management. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 28 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): Standards 31,33,35 and 38 were assessed. Quality in this outcome area is good. A person who is of good character and is committed to the care of the residents manages the home. Systems are in place to monitor the quality of care and health & safety to ensure the welfare of the residents is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of this home is a first level qualified nurse with 14 years experience in managing care homes for older people, many of these have also involved managing the care needs of people with dementia. The manager is committed to providing effective care to the residents and has completed ongoing training in dementia care to help promote this. She is Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 29 currently undertaking a degree in dementia studies which she explained is likely to take a period of five years to complete. The inspection process demonstrated that the management of this Home is effective and staff work well as a team to support the needs of the residents. The manager has a clear and structured approach on how care and services at the home can be further developed to benefit the residents. It was evident that the manager is willing to make changes necessary to enable the home to be seen as an excellent provider of dementia care. A comment card received by use from a relative states “it is obvious and evident that the manager is continually working to improve every aspect of the home and has a huge commitment to dementia care, her staff residents and their relatives and friends”. The manager was observed to have a good relationship with staff, residents and visitors to the Home. Visitors spoken to were complimentary of the manager and the care provided at the home. There are effective quality assurance systems in place. A satisfaction questionnaire is sent to relatives on an annual basis. The results of the last survey were viewed. Out of 37 surveys sent out, 13 were returned. Of these, eleven said they are given feedback on the care of their relative, ten said they are involved in the review process of the care of their relative, twelve said that staff were polite and courteous – one did not answer. There were many positive responses to the question “What is your general impression of the care and resources provided”? One person stated “I believe my relative is well cared for and resources reasonable/good. The senior carers guided by the manager are excellent – shown by the relationship with residents and visiting relatives”. Others responded “excellent”, “first class” and “could not ask for better”. No negative responses were given. Comment cards received by us contained many positive comments about the care and services provided. One person states, “Much effort has been made to enable X to have a better quality of life, X is a happier and sociable person again”. A resident comment card states “staff in the home are excellent”. The manager explained that they usually hold relative meetings on a three monthly basis but due to a variety of reasons these had not been maintained this year. She explained that she had however had individual meetings with relatives and has also instigated dementia care advice sessions for relatives, which had been positively received and attended. On the day of inspection, a dementia care advice meeting had been scheduled and several relatives had turned up to attend this. Questionnaires asking for Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 30 feedback in relation to these advice meetings were all very positive in their responses with many thanking the manager for organising this as it had given them a better insight into the needs of people with dementia. In addition to satisfaction questionnaires, the manager also undertakes audits linked to care and services provided in the home, such as medication, health and safety, laundry and kitchen services, care plans etc. This enables the manager to identify any potential areas for improvement as well as any areas, which are being managed effectively in the home. Residents’ personal monies are held for safekeeping in the home if requested. Money is stored in individual named plastic wallets and records are maintained of all expenditure and deposits made. The manager completes a slip showing any expenditure on hairdressing, chiropody and toiletries etc and invoices are devised based on information detailed on the slip. Receipts were not available for all transactions and the manager advised that the provider kept these for the accounts. As there was no reference to the original receipt on the slips kept and no copies of the receipt, it was not possible to fully confirm that the slips were accurate. Copies of original receipts should be kept to maintain an effective audit trail. On one slip tights were listed but these were not on the invoice, on another slip hairdressing was indicated and a receipt was available but this service had not been indicated on the invoice meaning residents had received these items/services but had not paid for them. All money available was accurate in regards to the records in place. The manager agreed to audit the financial records to ensure all were accurate. A review of health and safety records was undertaken. A copy of a gas safety record confirmed that the gas safety of the home had recently been checked. Records were in place to confirm electrical portable appliance testing had been done in 2007. The manager explained that fire drills are carried out with staff and she explained how this was managed, training records confirmed those staff that had participated in these. Records were seen to confirm the lift is being safely maintained. There was no certificate to confirm that the 5 year electrical wiring check had been completed. The Annual Quality Assurance Assessment forwarded to us by the manager states that this check was completed in July 2006. Evidence of this will need to be available to confirm the electrics in the home are safe. There were no records to show that the temperatures of the fridges and freezers were being measured to show that food is being stored safely. On measuring the temperature of one of the freezers it was demonstrated that this was operating at a higher level than the member of staff who records the temperatures thought it was. This will need to be monitored. Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 31 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 3 X 4 X X X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? N0 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 15 Requirement Care plans must clearly indicate the actions to be taken by staff in the event of hypoglycaemia or hyperglycaemia. Care plans also need to clearly show staff actions required to meet care needs consistently. Records must demonstrate that each individual resident need is being evaluated monthly and records any changes that have occurred. 2. OP27 17(2) Duty rotas in the home must be maintained accurately. They need to clearly identify hours/shifts worked by all staff, staff designations and full details of any agency staff who may cover shifts in the home so that there is clear audit trail. This is so that it is clear the home is sufficiently staffed consistently. 31/12/07 Timescale for action 31/01/08 3. OP38 13 Evidence needs to be available to 31/12/07 confirm the five-year electrical wiring has been checked and deemed safe. DS0000041396.V342529.R01.S.doc Version 5.2 Page 33 Sebright House Fridge and freezer temperatures must be maintained effectively to show that food is being stored safely and will not impact on resident health. 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 OP9 Good Practice Recommendations A protocol for the management of medications where “one or two” tablets/capsules is prescribed should be devised so that records are clear in regards to what has been given and received by the resident. Records need to be kept of the food provided to residents in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in regards to nutrition and otherwise. This includes records of any special diets being provided. It is advised that named contacts are detailed in the complaints procedure as well as contact addresses and telephone numbers so that it is clear there is an open and clear complaints procedure that relatives and visitors to the home can easily follow. A review of the bathroom facilities should be undertaken to improve the décor and ensure the baths are suitable for the client group the home are catering for. Action needs to be taken to address the bath chair with the “rip ties” and black/yellow tape to ensure the personal hygiene of residents can be addressed hygienically. Towels should be available in residents bedrooms at all times. 5. OP26 It is advised that the use of open weave laundry baskets for dirty laundry items is reviewed as these are difficult to DS0000041396.V342529.R01.S.doc Version 5.2 Page 34 2. OP15 3. OP16 4. OP21 Sebright House clean to maintain hygiene. 6. 7. OP26 OP29 The cooker in the main kitchen needs to be deep cleaned. Criminal Record Bureau (CRB) checks need to show that they have been instigated by the home and contain either the home address or name of company to demonstrate the home is operating effective recruitment practices to safeguard residents. All care staff need to complete statutory training within the required timescales. This in particular applies to food hygiene training. Evidence is needed that all staff have either completed food hygiene training or this is planned so that staff are clear on their responsibilities when handling food. A review of resident financial records should be undertaken to ensure there are receipts available for all transactions and invoices tally with the slips kept of expenditure. 8. OP30 9. OP35 Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 © 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 Sebright House DS0000041396.V342529.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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