Care Home: Sue Ryder Care Centre

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What the care home does well Cuerden hall presents as a very warm, caring and friendly care home and residents appeared relaxed and comfortable with the staff. It was evident through interviews, general observations and discussions that staff had a good knowledge of the residents` individual care needs and the level of support required. During our visit staff were observed spending a great deal of time with residents, either on an individual basis or within a group. Care was seen to be given in a discreet, sensitive manner and staff were patient and gentle in their approach. Feedback from residents was very good; comments regarding the service included: "Staff are excellent" and “The carers are very efficient and kind to me - they show such patience". Prior to admission the manager assesses residents’ health and social needs. Information collected is then used to form the basis for the plan of care. Assessment documentation seen had been completed to good standard and included key areas regarding the residents’ health and general well being. Care files were organised, the information easy to read and care plans identified the relevant care and support required. Attention is paid to recording basic needs such as dental, optical, hearing and foot care. Lots of different types of activities were arranged, both in the home and out in the community. The physical accommodation is of a good standard, with appropriate aids and adaptations available for the residents. The home has an experienced and enthusiastic team of staff who work well together and enjoy taking part in training and development sessions. The staff are motivated and keen to ensure that residents receive high standards of care. Staff comments included: “The home gives good training”; “The home looks after the residents well” and “Provide excellent individual care for each resident”. The manager was experienced and ran the home well. She made sure she checked out staff before they started working at the home and gave them training and support to make sure they did the job to the best of their ability. The manager communicates a clear sense of direction, is able to evidence a Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 sound understanding and application of ‘best practice’, particularly in relation to continuous improvement, resident satisfaction and quality assurance. What has improved since the last inspection? At the previous key inspection some risk assessments were not as accurate as they could be in relation to the system on the bed, and did not indicate why bed rails were used without bumpers and whether or not it was safe to do so. At this key inspection we found that a new risk assessment format was being used and that in general the way these were completed had improved. The ones looked at accurately demonstrated what type of bed system was in use and what other safety measures were needed such as protective bumpers. Examination of the care plans confirmed that more details of residents’ preferences, psychological matters, how to communicate with residents and details of specific conditions were now being included. The risk assessments for bedrails are accurately recorded to help ensure that the systems in use for some people were the safest and the most comfortable for the individual. The medication management had improved and residents were being given their medicines as prescribed to ensure they worked effectively. Staff recruitment had been improved by using more appropriate referees who would give an objective and accurate view on people’s suitability for work. What the care home could do better: Residents should be encouraged to take part in the review of their care. Parts of the building should be improved to make a more pleasant environment for residents, such as repairing damaged tiles. An environmental audit should be undertaken to ensure that ongoing repairs can be identified. Key inspection report CARE HOME ADULTS 18-65 Sue Ryder Care Centre Cuerden Hall Shady Lane Bamber Bridge Preston Lancashire PR5 6AZ Lead Inspector Bernard Tracey Key Unannounced Inspection 5th November 2009 09:00 Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 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 home adults 18-65 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. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 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 Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Sue Ryder Care Centre Address 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) Cuerden Hall Shady Lane Bamber Bridge Preston Lancashire PR5 6AZ 01772 627374 01772 629290 sara-sally.cook@suerydercare.org www.suerydercare.org Sue Ryder Care Sara Jane Cook Care Home 37 Category(ies) of Physical disability (37), Terminally ill (6) registration, with number of places Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home is registered for a maximum of 37 service users to include: Up to 37 service users in the category PD - Physical Disability Up to 6 service users in the category TI - Terminally Ill Date of last inspection 24th September 2008 Brief Description of the Service: Sue Ryder Care Centre is situated in Bamber Bridge in a formerly stately home. The home is set in eleven acres of parklands with easy link to the motorway network. Local amenities are not within easy reach as the home is secluded within its own grounds. Sue Ryder Care Centre is a thirty-seven bedded care home, which provides residential, nursing and day care to younger physically disabled people between the ages of eighteen and sixty-five and both male and female. The home was opened 18 years ago to provide long term care for people with long term and or degenerative illnesses such as Huntington’s disease, multiple sclerosis, acquired brain injury and other neurological disorders. Accommodation is provided on three floors in single or shared rooms. There is wheelchair access and a passenger lift to all floors. Other facilities include a large activities area, physiotherapy department and a range of specialist equipment tailored to meet the residents’ needs. The home has a designated activities team that provides a wide range of recreational events and activities. Current weekly fees start at £633 with no upper limit, as this is dependent upon assessment of needs. Additional extras like hairdressing, chiropody, newspapers, outings etc are paid for by the residents. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience Good quality outcomes. The last key Inspection was undertaken on the 24th September 2008. In March 2009 we undertook a Random Inspection of the service. The reason for this inspection was to monitor the progress made on some legal requirements made at the last key inspection on 24/09/08. At this last key inspection, and following a serious incident involving bedrails, there were still concerns about some of the bed rails used in the home, particularly about the way some were fitted, the way the risk to people from different bed rail systems was assessed, the systems in place for identifying and rectifying faults and problems, and the number of staff who had not at that time undertaken training in the safe use of bed rails. Some concerns about medication management were also identified. An action plan had been submitted following the last key inspection that indicated that all the issues of concern highlighted had been addressed. We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. The staff at the home did not know the visit was going to take place. The manager was asked to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, these comments have been included in the report. We spent six and a half hours at the home over one day. During this time, we looked at care and medicine records to ensure that health and care needs were met and also studied how information was given to people before they decided to move into the home. A tour of the building was undertaken and time was spent looking at records regarding safety in the home. We also examined files that contained information about how the staff were recruited for their jobs, as well as records about staff training. We spent time speaking to five residents, as well as speaking to four staff, two visitors and the Manager and her deputy. We have received one complaint about the service since our last Inspection. This complaint was addressed during our Random Inspection and a report was produced. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 6 What the service does well: Cuerden hall presents as a very warm, caring and friendly care home and residents appeared relaxed and comfortable with the staff. It was evident through interviews, general observations and discussions that staff had a good knowledge of the residents individual care needs and the level of support required. During our visit staff were observed spending a great deal of time with residents, either on an individual basis or within a group. Care was seen to be given in a discreet, sensitive manner and staff were patient and gentle in their approach. Feedback from residents was very good; comments regarding the service included: Staff are excellent and “The carers are very efficient and kind to me - they show such patience. Prior to admission the manager assesses residents’ health and social needs. Information collected is then used to form the basis for the plan of care. Assessment documentation seen had been completed to good standard and included key areas regarding the residents’ health and general well being. Care files were organised, the information easy to read and care plans identified the relevant care and support required. Attention is paid to recording basic needs such as dental, optical, hearing and foot care. Lots of different types of activities were arranged, both in the home and out in the community. The physical accommodation is of a good standard, with appropriate aids and adaptations available for the residents. The home has an experienced and enthusiastic team of staff who work well together and enjoy taking part in training and development sessions. The staff are motivated and keen to ensure that residents receive high standards of care. Staff comments included: “The home gives good training”; “The home looks after the residents well” and “Provide excellent individual care for each resident”. The manager was experienced and ran the home well. She made sure she checked out staff before they started working at the home and gave them training and support to make sure they did the job to the best of their ability. The manager communicates a clear sense of direction, is able to evidence a Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 7 sound understanding and application of ‘best practice’, particularly in relation to continuous improvement, resident satisfaction and quality assurance. What has improved since the last inspection? What they could do better: 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed assessments are undertaken before people come into to the home and sufficient information is provided so they can feel confident that their needs can be met. EVIDENCE: Feedback from our discussion with residents indicated that the majority felt they had been given sufficient information about the home prior to moving in, including an opportunity to look round the home before making the decision. Comments received included: Its brilliant here – safe warm and they care for us really well When I first seen this home I fell in love with it In the completed Annual Quality Assurance Assessment the manager told us; each service user is provided with a statement of purpose and a service user guide, visits to the home were organised and transport provided if required, overnight stays were encouraged. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 10 Admissions are planned and range from short visits to trial placement depending on the needs and wishes of the person. Each resident is issued with a contract, which covers the values, key principles and expectations of the resident including care and support. Two residents both said it was helpful to meet someone from the home before they moved in. Before any resident was admitted to the home an assessment of their needs was undertaken, by a senior member of the staff from the home and from the professional, i.e., care manager, requesting their admission. Assessments we examined on file supported this. The files showed that care management assessments had been completed by social workers. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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): 6, 7 & 9 People using the service experience good quality outcomes in this area. People living at the home are provided with information and support enabling them to make decisions about activities of daily living. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The care plans we looked at are extremely informative enabling the care staff to identify with residents’ specific care needs, together with their preferences, likes and dislikes. All health, social and emotional care needs are identified and individual care plans are prepared for each of the identified need. The care plans are signed by the resident to confirm agreement with them. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 12 Residents spoken to on the day of the inspection confirmed that they had discussed the care plans with the manager or nurse and were able to discuss their preferences in relation to meals, times of going to bed and getting up and how they liked things done. Residents have choice over their personal care and are encouraged to be independent and responsible for their own personal hygiene where possible. Risk assessments are undertaken on all residents in relation to daily living and appropriate measures are put in place to reduce or remove any potential risk. These are recorded in the care files. Residents felt were treated with respect and in a dignified manner at all times. Privacy is respected at all times. Residents are free to meet with their visitors in the privacy of their own bedroom or in one of the communal areas. Residents spoke highly of the manager, the care and ancillary staff and commented on how committed and caring they were. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12 13 15 16 17 People using the service experience excellent quality outcomes in this area. Residents are able to enjoy a full and stimulating lifestyle with a variety of opportunities to choose from. Staff are skilled at promoting choice and control in residents’ lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The range of leisure activities available in the home was varied, reflecting the diversity of residents and their social, intellectual and physical capacities. The home has a dedicated activity co-ordinator, supported by volunteers, who organise events and activities within the home, as well as trips out to various places of interest Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 14 We met with the Activity co-ordinator during our visit to the home. She has sought the views of residents and considered their varied interests and abilities when planning the routines of daily living and arranging activities. Routines are very flexible and residents can make choices in major areas of their life. The routines, activities and plans are resident focussed, regularly reviewed and can be quickly changed to meet individual residents’ needs. Each resident has their own activities and interest assessment completed and their interests are recorded and a programme agreed to reflect their personal preferences. Links with the community were good and valued the role which relatives and friends continued to play in the lives of residents. Residents benefited from being able to exercise choice and control over their lives. The manager and staff are aware of promoting equality and diversity and encourage the residents to develop a lifestyle and interests that are individual to them. Some residents choose to take part in group activities, such as going for bar meals, walks, bowling, while others have chosen to pursue their own interests. Residents we spoke to said they enjoyed the food, that they receive enough to eat and drink. We observed staff being attentive during the lunchtime period, asking if people had finished their meal before they removed their plate, asking if they wished for some more and offering a choice of starter, main meal and dessert. The dining tables were set appropriately – table clothes, cutlery, serviettes and jugs of water. Staff were observed assisting the residents during mealtimes in a discreet way but ensuring each person was able to enjoy food of their choice. Staff carried out their care and support duties in a way that enables residents to maintain choice and control over their daily lives wherever possible. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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): 18, 19 & 20 People using the service experience good quality outcomes in this area. Residents are supported by staff and relevant health care professionals to ensure that their emotional, physical and personal care needs are met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Individual care plans are in place for each resident. The plan sets out how the current and anticipated needs are to be met. We looked at two care plans in detail. All care plans and risk assessments are reviewed on a regular basis or as changes in care needs are identified, and these are updated as appropriate. Staff actively promote the residents’ right of access to the health and remedial services that they need, both within the home and in the community. Regular appointments are seen as important and there are systems in place to make sure appointments are not missed. Records show that the home arranges for health professionals to visit frail residents in the home and provides facilities to carry out treatment. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 16 Records held in the home provide evidence of the input by other healthcare professionals and advice is sought from the Dietitian and the Tissue Viability Specialist Nurse as necessary. The manager was able to describe how residents and their relatives are involved in the drawing up of the care plan and understood the meaning of a care plan to describe the assessed needs of a resident and how the needs were to be met. The care plan would also include any changes in the resident’s condition. Signatures in the care plans, indicating that the individual agreed with the plan and any alterations made to it after consultation with the individual, should be obtained to confirm this involvement. The care plan is generated from the single care management assessment and the assessment provided by the home. The plan sets out how the current and anticipated needs are to be met. There is evidence that the residents together with family, friends or advocate are involved in the drawing up of the plan. Any potential restrictions on choice, freedom, services or facilities that become part of the resident’s daily life, had been discussed and agreed with the resident during assessment and recorded in the care plan. Two residents spoken with confirmed that they had been given “all the information about how the home is run before coming in the place.” One resident said he had “come on a trial basis and decided to stay”. The home has a robust medications policy and inspection of the medications records provide evidence that the staff follow the procedure. All records relating to medications were found to be well maintained and up to date. The medications room and trolley were seen to be clean and organised. Appropriate arrangements are in place for the disposal of unwanted medications through a contract with a disposal company. At the time of our visit no individual resident was managing their own medication. Wherever possible, residents are encouraged to manage their own finances and, at the time of the inspection, most residents were taking personal control over their money. We visited the home in March. The reason for this inspection was to monitor the progress made on some legal requirements made at the last key inspection. At this last key inspection, and following a serious incident involving bedrails, there were still concerns about some of the bed rails used in the home, particularly about the way some were fitted, the way the risk to people from different bed rail systems was assessed, the systems in place for identifying and rectifying faults and problems, and the number of staff who had not at that time undertaken training in the safe use of bed rails. Some concerns about medication management were also identified. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 17 An action plan had been submitted following the last key inspection that indicated that all the issues of concern highlighted had been addressed. Our observations at the Random Inspection in March and at this Key Inspection confirmed that the arrangements were now in place to meet the requirements made and that the safety of the residents had been secured. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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): 22 & 23 People using the service experience good quality outcomes in this area. Residents were confident that complaints would be listened to, taken seriously and acted upon. Appropriate systems were in place to protect residents from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A clear, detailed formal complaints procedure is displayed in the reception area of home and provided to each resident, supporting the home’s open culture, where residents were encouraged to express their views informally and in the regular residents’ meetings. Residents felt staff listened to them and they knew who to talk to if they were unhappy or had any concerns. A resident stated “It would be hard to complain about anything here - the place is good”. There was information readily available about the use of advocacy services and where people could get advice if they needed it. The advocacy service is used for anyone who would like an independent person to act on their behalf so that they are given the same opportunities as others and so that their affairs are protected. The home had started working towards implementing strategies around the Mental Capacity Act so that everyone living at the home was given the same opportunities. The arrangements for the care of people who lack the capacity to consent are made following a best interest decision taken by a team of professionals. No person is presently being deprived of their liberties. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 19 The Care Quality Commission had received a serious incident report since the last inspection – dealt with by our visit in March and reported on in our Random Inspection report. Abuse awareness training was provided to all new starters, with annual updates. Staff understood the importance of listening to residents’ concerns and how to respond to any issues that were raised. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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): 24 & 30 People using the service experience adequate quality outcomes in this area. The home provides a comfortable and clean environment for the residents. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A tour of the building showed that the home was comfortable and adequately furnished including easy chairs and sofas in keeping with the residents’ age group. There was a choice of communal areas and extensive and attractive grounds and gardens for residents to enjoy. Bedrooms were personalised and spacious, though some were shared which reduced people’s opportunities for privacy. Residents were able to furnish their rooms with some of their own personal items such as chairs and small tables. Some residents were encouraged to look after their rooms if they were able to. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 21 There had been some improvements to the premises since the last key inspection. More radiators had been covered, and there was only one that remained uncovered - in a currently empty room. This radiator was to be covered in the near future when the room concerned is decorated. The dining room and reception area had been redecorated and made brighter. However in spite of the stated rolling programme of maintenance and decorating, and regular checks being made, there were a number of areas that needed repair and improvement. The manager is aware of this and needs to produce an environmental audit with timescales for repairs and renewals to improve the standards within the home. Residents had all the equipment they needed to assist them to be comfortable, mobile and independent. There was a physiotherapy room, with equipment, and residents had specific chairs and wheelchairs for their own use. There were several adapted bathing and shower facilities. The shower room on the ground floor needs repairs to the broken tiles and boxing in of the pipes below the corner sink. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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): 32, 34 & 35 People using the service experience good quality outcomes in this area. The staff team had collective skills training and expertise to undertake their roles effectively and good recruitment and selection procedures were in place to ensure that the residents were protected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Three staff files were viewed with regard to recruitment practices and these contained all of the necessary checks to protect the residents. Staff had completed a job application form and two references had been obtained. Staff files contained a POVA (Protection of Vulnerable Adult) check and CRB (Criminal Record Bureau) disclosure at enhanced level. The necessary checks are in place prior to staff commencing work and the interviewer completes an interview checklist. Staff are given a health declaration form to complete and a contract of employment. Computerised individual staff training records provided a clear summary of both induction and ongoing training. This was extensive and wide ranging, with mandatory courses, i.e., moving and handling, medication, fire safety, Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 23 and first aid. Specialist training included care planning, risk assessment, mental health, suicide and self-harm and challenging behaviour. This training package was confirmed by the manager and was identified in the written AQAA she had provided us with. Similarly, staff who were interviewed confirmed that training was available, that they were encouraged to attend and that it gave them appropriate competencies to meet the needs of the residents. A staff member commented, “the training is excellent here”. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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): 37 39 & 42 People using the service experience good quality outcomes in this area. Residents are able to enjoy a full and stimulating lifestyle with a variety of opportunities to choose from. Staff are skilled at promoting choice and control in residents’ lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Cuerden Hall Care Centre is owned by Sue Ryder Care and managed by trustees. A manager is employed to run the home on a day-to-day basis. This person is registered with the Commission and has the appropriate nursing and management qualifications. Other senior managers from the Sue Ryder organisation visit the home on a regular basis and support the manager and the staff. The “responsible individual” carries out monthly, unannounced Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 25 visits to the home under the Care Homes Regulations to monitor all aspects of the services and running of the home. Staff and residents meetings assisted communication of ideas and new developments. There were a number of ways of listening to residents and including their views in the planning and development of services. Residents had day-to-day contact with the manager and staff, and felt able to discuss any matters of concern or ideas. Regular residents meetings were also held. Residents’ views were then fed into staff and management meetings. The Sue Ryder organisation has recently appointed a “Service User Involvement Lead” to facilitate the involvement of residents in the planning and development of services. The Sue Ryder organisation has health and safety procedures to help protect the health and welfare of residents and staff, and information provided by the home prior to, and on, the site visit stated that all installations, appliances and some equipment had been serviced and maintained appropriately. However, since the previous key inspection there had been a serious incident involving a specialist bed system. As part of the action taken by the home to prevent such incidents happening again, and since the previous unannounced inspection, a number of policies and procedures relating to the use of bed rails had been reviewed and developed. This was part of a detailed action plan submitted to the Commission, and included new systems for risk assessments, staff training, the reporting of faulty equipment and the recording of the repairs carried out. Some of these have been highlighted above in the relevant sections of the report. In addition a report had been commissioned on the condition of the beds in the home, which had resulted in a number of beds being replaced. Records we examined confirmed that a robust and detailed audit of all bedside rails is being undertaken and reported on. The manager and staff work hard to maintain a culture, where everyone feels they are included in decision-making and feel valued as an individual. There is a good system in place to gather staff, residents and relatives’ views through regular meetings and satisfaction questionnaires as part of the monitoring of quality. Staff spoken to have a clear understanding of their role and what was expected of them. Documentation was examined that confirmed that staff received regular supervision and annual appraisal. Residents, and visitors spoke well of the management team and the care and support that they give. We were able to witness their approach to the residents and staff and confirm the comments made. Information provided by the manager in the AQAA and examination of the records, confirmed that all safety equipment is regularly serviced. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 26 The policies and procedures in the home ensure that the health, safety and welfare of the residents and staff are promoted and protected Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X Version 5.3 Page 28 Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Yes Are there any outstanding requirements from the last inspection? 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 YA24 Regulation 23(b)(d) Requirement Damaged areas within the home must be restored and redecorated to an acceptable standard. Outstanding Requirement in the timescale of 30/04/09 Timescale for action 30/01/10 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 YA19 Good Practice Recommendations Evidence should be provided that residents are involved in the review of their care to ensure that their views and wishes are being taken into account. Sue Ryder Care Centre DS0000025555.V378499.R02.S.doc Version 5.3 Page 29 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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