Care Home: Sundridge Court Nursing Home

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What the care home does well The service provides people with information to help them decide if Sundridge Court is the right home for them, and assesses people’s needs before they are admitted to make sure the home can meet them. Staff members treat residents with respect and uphold their privacy and dignity. Residents are supported to maintain contact with their families and friends, provided this is their choice. The service makes sure residents’ nutritional needs and preferences are met and it maintains high standards of food hygiene. Residents live in a home that is clean and comfortable, and that is maintained well. They are provided with an efficient laundry service.Sundridge Court Nursing HomeDS0000010144.V376233.R01.S.docVersion 5.2The service operates robust staff recruitment procedures that support and protect residents, and makes sure staff members have access to the training they need for their work with residents. The service consults residents, their representatives and staff members about the quality of services provided and about the running of the home. The home is managed well, in ways that are open and inclusive, and the manager is readily available to residents or their representatives. What has improved since the last inspection? Improvement to particular aspects of the service provided was evident and this has been reflected in the new quality rating for Sundridge Court. The home has addressed the requirements we made at our last inspection. Pre-admission assessments are now being fully completed, signed and dated. This means that important information about each resident’s needs is recorded and it is possible to know when and by whom an assessment has been carried out. Residents now have fully completed care plans and risk assessments, which helps to make sure they get the care and support they need. Care needs are being reviewed regularly and, whenever possible, care plans are discussed with residents and/or their representatives. Care delivery is recorded so it can be seen that residents’ specific care needs have been met. Medicine administration has improved so that residents now benefit from safe and effective practice. Environmental improvements include the installation of a new shower room on the upper floor, new floor coverings in corridors and the conservatory, redecoration of some rooms, and new furniture for the dining room. More permanent care staff have been recruited, which means residents benefit from greater continuity of care. A resident commented that “staff are always friendly, helpful and welcoming especially now that most are permanent and really know the residents’ particular needs”. What the care home could do better: Although they promote people’s health and safety, there are some matters that require attention. They need to make sure: wheelchair footplates are always used to prevent injury to residents; that portable fans are risk assessed in respect of people’s safety; and that cleaning products are not left unattended.Sundridge Court Nursing HomeDS0000010144.V376233.R01.S.docVersion 5.2They are now managing the administration of medicines well but they need to make sure their controlled drugs cupboard is of the appropriate design and installed correctly. They could improve how they record activities, with more evaluative comment to show outcomes for residents. They should review the number of cleaning staff working in the home to make sure there are enough on duty each day. They need to continue their efforts to ensure care staff receive formal supervision at least six times each year. Key inspection report CARE HOMES FOR OLDER PEOPLE Sundridge Court Nursing Home 19 Edward Road Bromley Kent BR1 3NG Lead Inspector David Lacey Key Unannounced Inspection 8th July 2009 10:00 DS0000010144.V376233.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sundridge Court Nursing Home Address 19 Edward Road Bromley Kent BR1 3NG 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) 020 8466 6553 020 8466 5180 office@sundridgecourt.fslife.co.uk Harley Healthcare Nursing Homes Limited Margaret Anne Candy Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (1) of places Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 18 December 1998 Date of last inspection 9th September 2008 Brief Description of the Service: Sundridge Court is situated in a quiet residential area of Bromley. It is a purpose-built home providing nursing care for up to thirty older people. Bedrooms have en-suite facilities and a passenger lift provides access to each floor. Communal space includes a lounge, conservatory and a dining room, and there is a laundry on-site. The home has a large back garden with patio seating and there is some off-street parking at the front of the building. A bus route and Sundridge Park rail station are within reasonable walking distance for those with full mobility. The fees for this home are £750 - £1100 per week (this information given to CQC in July 2009). Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars, which means that people using the service receive a good service. This key inspection included an unannounced visit to the care home, which took place over two consecutive days. The inspector spoke with some of the residents and relatives, and met with the registered manager, area manager and members of the home’s staff. The care given to four residents was looked at in detail. Documentation was sampled for inspection, such as care plans, medication records, staff recruitment files, and policies and procedures. The commission surveyed samples of those people who live or work in the home and people who visit the home to get their views about the services provided. The responses received are summarised in this report and have been taken into account in reaching our judgements. We sent out questionnaires to ten residents, six relatives, six staff members, and four visiting professionals. By the time of writing this report, completed surveys had been received from six residents, three members of staff, and one health care professional. Each of the six residents indicated they had received help from someone in completing their survey forms. Information from the home’s Annual Quality Assurance Assessment (AQAA) has also been used to inform the inspection process. What the service does well: The service provides people with information to help them decide if Sundridge Court is the right home for them, and assesses people’s needs before they are admitted to make sure the home can meet them. Staff members treat residents with respect and uphold their privacy and dignity. Residents are supported to maintain contact with their families and friends, provided this is their choice. The service makes sure residents’ nutritional needs and preferences are met and it maintains high standards of food hygiene. Residents live in a home that is clean and comfortable, and that is maintained well. They are provided with an efficient laundry service. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 6 The service operates robust staff recruitment procedures that support and protect residents, and makes sure staff members have access to the training they need for their work with residents. The service consults residents, their representatives and staff members about the quality of services provided and about the running of the home. The home is managed well, in ways that are open and inclusive, and the manager is readily available to residents or their representatives. What has improved since the last inspection? What they could do better: Although they promote people’s health and safety, there are some matters that require attention. They need to make sure: wheelchair footplates are always used to prevent injury to residents; that portable fans are risk assessed in respect of people’s safety; and that cleaning products are not left unattended. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 7 They are now managing the administration of medicines well but they need to make sure their controlled drugs cupboard is of the appropriate design and installed correctly. They could improve how they record activities, with more evaluative comment to show outcomes for residents. They should review the number of cleaning staff working in the home to make sure there are enough on duty each day. They need to continue their efforts to ensure care staff receive formal supervision at least six times each year. 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. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 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. People are given helpful written information about the home and can visit before making a decision whether to move in. Prospective residents may be assured their needs will be assessed to ensure the home can meet them, and that they will be provided with contracts/statements of terms and conditions with the home. EVIDENCE: The home makes information about its services readily available to residents, their families or any other interested parties. Our most recent inspection report was on display in the home’s reception area, together with copies of a leaflet that people could take away offering general advice about choosing a care home. All of the residents who responded to our survey stated they had Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 10 received enough information to help them decide if this home was the right place for them, before they moved in. It was evident that some residents had been helped to choose the home, often because their conditions had prevented them from visiting the home before moving in. One resident commented that, a care manager appointed the home for me. Some relatives visiting the home told the inspector they had chosen this home among a number that were suggested by a local hospital before their relative was discharged. When they visited Sundridge Court, “the staff were lovely, the place looked very nice and we thought it was the best place for her”. They were pleased with their choice, saying “if it hadn’t proved to be good she wouldn’t still be here, we would have moved her”. Five of the six residents who responded to our survey confirmed they had received a contract with written information about the homes terms and conditions, and one resident stated s/he did not receive a contract. During the inspection, contracts were seen on file for three residents selected at random. It was understood that people who stay at the home for short-term respite care are provide with a letter confirming the details for their stay rather than a full contract. An example of this was seen for one resident, which included the relevant agreement from the placing authority. Pre-admission assessments of prospective residents’ needs are carried out by senior staff from the home and, from sampling relevant documentation, it was evident the recording of these assessments had improved since our last inspection. The assessment documentation inspected had been fully completed, signed and dated. This meant that important information about each resident’s needs had been recorded and it was possible to know when or by whom the assessment had been carried out. The manager stated the home accepts referrals of people from any ethnic groups or cultures, provided their care needs can be met at Sundridge Court, and that there are policies and procedures in place to support this. Specific cultural needs, such as dietary requirements, would be identified as part of the pre-admission assessment process. A small proportion of residents had dementia, which the manager confirmed was secondary to other problems for which they needed nursing care. Case-tracking of a resident who had dementia showed this was secondary to other conditions for which she needed the nursing care that the home was providing. Sundridge Court does not offer intermediate care, therefore standard 6 does not apply. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 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. Residents are satisfied with the care they receive, including medical care, and have access to local health care services when they need them. Care plans and risk assessments are drawn up when a person is admitted and residents can be confident that staff members have full written guidance about meeting their needs. Medicine administration has improved so that residents now benefit from safe and effective practice. The home’s staff members treat residents with respect and uphold their privacy. EVIDENCE: The care of four residents was looked at in detail. Improvements in care documentation were noted, with those seen having fully completed care plans and risk assessments, to make sure the residents get the help and care they need. Care needs had been reviewed regularly, and it was also evident that Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 12 care plans had been discussed with residents and/or their representatives. Care delivery had been recorded for those residents case-tracked during the inspection, so it could be seen that the care that residents had been assessed as needing, such as wound care, had been delivered. Of the three staff members who responded to our survey, two stated they always receive up to date information about residents needs, for example, in the care plan, and one stated this is usually the case. Five of the six residents who responded to our survey stated they always receive the care and support they need, with one resident stating this is usually the case. Five of the six residents stated they always receive the medical care they need, and one stated s/he usually receives this. The health care professional responding to our survey stated that the home usually monitors, reviews and meets peoples health and social care needs, and that the home usually seeks advice and acts on it to meet peoples health and social care needs and improve their well-being. Two of the three staff members returning our questionnaire stated the ways in which they share information about residents with other carers and the manager usually work well, the third staff member stating this is sometimes the case. A resident seen in her room said it had been a big change for her moving into a care home but she had settled in well and now enjoys living here. She said the staff are very caring and “do their best to make sure I’m comfortable”. Another resident seen in her room was being nursed in bed for much of the time, though was being helped to get out from bed as often as possible. She said she was comfortable and that carers make sure she has what she needs, such as the call bell to hand and a drink within easy reach. Her bed had a pressure-relieving mattress and staff were maintaining a chart to show when the resident had been helped to change her position in bed. Another resident who was in bed when speaking with the inspector also had a pressure-relieving mattress in place. This resident had also been made comfortable, had a drink within reach, and knew how to use the call bell to get help if needed. Two visitors who spoke with the inspector were very pleased with the standard of personal care given to their relative. They said she always appears well looked after, clean, well groomed and dressed, with her hair done and nails trimmed. Of the three staff members responding to our survey, two replied they always have enough support, experience and knowledge to meet the different needs of residents and one stated this is sometimes the case. We had asked that staff members consider needs relating to disability, gender, age, race and ethnicity, faith and sexual orientation. The health care professional responding to our survey stated that the home usually responds to the diverse needs of individual people. The registered manager confirmed during the inspection that the home will admit older people of any ethnicity, faith or sexual orientation who need nursing care, and stated there are policies in place to reflect this. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 13 The home had changed its supplying pharmacist a few months before the inspection, and the deputy manager had been given designated responsibility for the day to day management of medicine administration in the home. Improvements were noted since our previous inspection and it was evident the home had addressed the requirements we had made about their management of medicines. Receipt, administration and disposal of medicines were satisfactory. Records of the disposal of medicines were being kept, which met our previous requirement in this respect. A sample of four medicine administration records was examined and found to be satisfactory with no unexplained gaps in entries. Variable doses had been recorded so the number of tablets given was evident. There was evidence of monitoring of ‘as required’ medicines, with the doctor being asked to prescribe regular doses if an as required medicine was being taken regularly by a resident. The GP had reviewed and signed the homely remedies protocol in December 2008. Homely remedy medicines in stock had records of receipt and administration, which also met one of our previous requirements. The controlled drugs (CD) being stored on behalf of residents were checked and the stock held matched the entries in the home’s register. The CD cupboard had bolts but appeared to be fixed to a false wall. The home must check it is in compliance with the relevant legislation, which requires they have a CD cupboard of the appropriate design that is installed correctly. In brief, the requirements for CD storage are a metal cupboard of specified gauge with a specified double locking mechanism, which is fixed with either rawl or rag bolts to a solid wall or a wall that has a steel plate mounted behind it (see requirements). Staff spoke to residents in a polite and appropriate manner, and were seen to knock before entering a resident’s room. From discussions with staff, it was evident they knew about respecting residents’ privacy and dignity when giving personal care. The health care professional responding to our survey stated that the home usually respects peoples privacy and dignity. The Director General for Social Care at the Department of Health had visited the home in June 2009 to celebrate Sundridge Court becoming the 6000th Champion for the Dignity in Care campaign. During the inspection visit, a visiting professional was seen giving foot care to a resident with the bedroom door open on to a corridor, with the potential for loss of privacy and dignity. The manager was concerned to hear about this and agreed to take action to make sure it was not repeated with other residents. The manager explained the home was aiming to build on its existing good practice in end of life care by working with a local hospice towards accreditation in this respect (Gold Standards Framework – GSF). A link nurse from the hospice had been visiting the home regularly and staff had attended relevant training, for example, in the use of syringe drivers. There were no residents receiving palliative care at the time of this inspection but evidence of advance care planning discussions were seen on care files sampled. The home Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 14 is involved in a “Wish Passport” project, with the local Primary Care Trust. The inspector was told the hospice has asked if the home would agree to this being made more widely available within the GSF, as it can facilitate end of life conversations. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are normally available for residents to engage in as they choose. Residents are enabled to make choices and have their preferences met wherever possible. Residents are supported to maintain contact with their families and friends, provided this is their choice. Residents appreciate the quality of food provided, and may be confident their dietary needs will be met. EVIDENCE: At the time of the inspection visit, the home was temporarily without an activities coordinator. The post had recently become vacant and it was understood recruitment to fill the vacancy was underway. The inspector was told that in the meantime the activities programme was not being delivered and no planned activities were seen taking place during the inspection visit. We had surveyed residents before the coordinator post became vacant. Five of the six residents who responded to our survey stated there are always activities arranged by the home that they can take part in if they want, and Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 16 one said this is usually the case. As a result of this feedback and because the home was already taking action to re-establish its activities provision, we have not made any related requirements at this time. However, it was evident the recording of activities could be improved with more evaluative comment to show outcomes, and this is something the home should address once a new coordinator has been recruited (see recommendations). To help meet residents’ individual needs and choices, the home uses a questionnaire to identify people’s individual preferences. Completed questionnaires were seen on files sampled, as well as life histories to which next of kin had contributed. Visiting is encouraged at any reasonable time, and residents are supported to keep in touch with their families and friends, provided this is their choice. Families are encouraged to take out their relatives when possible, with support from staff as needed. For example, a resident being case-tracked had enjoyed a trip out from the home with a relative a few days before the inspection. It was evident the home makes sure residents’ nutritional needs are assessed and met. Nutritional assessments were seen on residents’ care files. All residents are weighed each month and some are weighed more often if required. There is good liaison between the manager and the chef, which benefits residents in terms of their nutrition. For example, at the time of the inspection there were six people on high calorie diets and two on reducing diets. The list of these residents and their dietary requirements had been signed by both manager and chef, to ensure the right diets are given to the right people and that outcomes could be monitored. Fluids are encouraged and it was noted written instruction had been given to the kitchen that residents should also be offered ice lollies during the hot weather. The inspector met with the home’s chef and looked at the menus. These indicated that a varied and nutritious diet was being provided. The home now offers a starter as well as a main course for lunch. The chef confirmed snacks are always available in the evening if people want something to eat between supper and breakfast the next day. Two of the six residents responding to our survey stated they always like the meals at the home, two that they usually do and one stated s/he sometimes likes the meals provided. Some visitors told the inspector how pleased they were that their relative had put on weight since being in the home, saying “she eats things she’s never eaten before”. A carer brought their relative some soup and the visitors said she had never eaten soup before “but now she loves it”. One resident was spoken with in his room not long after breakfast. He said, “I could hardly get it down me - porridge, eggs and bacon, lovely!” The proposed extension to the dining room is mentioned under standard 19 below, and from the evidence of this inspection it was apparent the home could potentially exceed the standard for meals and mealtimes when this environmental improvement is completed. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate policies and procedures for complaints and for safeguarding adults. Residents and their representatives may be assured that any concerns or complaints they raise will be taken seriously. Staff members receive training and are aware of their responsibilities in protecting residents from abuse. EVIDENCE: Complaints were being managed appropriately, in accordance with the organisation’s complaints procedure. A copy of this procedure, made specific to Sundridge Court, is displayed prominently in the home and a copy is also provided in the guide given to each resident. There is a ‘suggestion box’ in the reception area where people can post their comments. All of the six residents who responded to our survey stated there is someone they can speak to informally if they are not happy, and these six residents also confirmed they knew how to make a formal complaint. All three staff members responding to our survey confirmed they knew what to do if someone has concerns about the home. The health care professional replying to our survey stated that the home has usually responded appropriately when any concerns have been Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 18 raised. Relatives who spoke with the inspector said they knew how to make a complaint but had never needed to do so, “we have no complaints at all”. The home’s complaints file had records of any complaints received month by month, with a separate file for verbal complaints or concerns. Some complaints had been passed to the company’s head office so the responses to these were not being held locally. A high proportion of the complaints received in 2009 had been about an above-inflation increase in the company’s fees, and these had been passed to the head office for response. The commission had been made aware of a complaint about aspects of the care of a former resident, which had been passed to the provider for investigation and response. Discussion with the manager and area manager during the inspection, and examination of relevant documentation showed the complaint was being managed in accordance with the company’s procedures. During both days of the inspection visit, there were signs of wellbeing amongst residents, who appeared comfortable and relaxed when interacting with staff members. All staff members are required to attend training in safeguarding adults. The home also promotes the protection of residents from abuse through its policies and procedures. Copies of the local council’s leaflet about how to stop abuse were available in the home’s reception area. Staff members spoken with knew about their responsibilities to report any concerns they might have about residents’ safety and welfare. The commission is not aware of any allegations about this home since our last inspection. The manager had completed training about the deprivation of liberty safeguards and said training to raise awareness of these safeguards would be cascaded to all staff. It was understood the home would be setting up elearning for staff and may send them on a training course offered by the local council. The home provides contact details of the local independent advocacy service. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 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. Residents live in a home that is clean and comfortable, and that is maintained well. The provider has infection control procedures for the home’s staff to follow to ensure effective hygiene. EVIDENCE: The home was clean and tidy on the days of inspection. All of the six residents who responded to our survey stated the home is always fresh and clean. The only odour noted during the inspection was confined to one bedroom, which had strong odour. This was already known to staff and was understood to require replacement of the floor-covering in this particular room. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 20 Some environmental improvements had taken place since our last inspection. A new shower room had been installed on the upper floor, there was new carpeting in corridors, replacement flooring in the conservatory and some walls had been redecorated. A resident said she thought there had been “a lot of improvements” to the home over the past year and spoke about the new furniture and carpets in particular. New dining tables and chairs had been provided, and it was understood there are plans to extend the dining room. This should enhance residents’ dining experience as, at present, some need to have their meals on individual tables in the lounge or conservatory because of limited space in the dining room. The parker bath in the communal bathroom on the upper floor faces clinical cupboards and trays with aprons. The room was stark, with no natural lighting and no pictures on the walls but effort could be made to make it into a more relaxing place for residents to enjoy a bath. During the second day of the inspection, a cleaning trolley was seen left in this bathroom and this is commented on below under standard 38. We had previously recommended that doors to residents’ bedrooms are fitted with locks suited to their capabilities and accessible to staff in emergencies, and that residents should be provided with keys unless their risk assessments suggest otherwise. Care files seen during this inspection documented that residents have now been asked if they would like a room key. The AQAA stated the home has an action plan to deliver best practice in prevention and control of infection but this was not available for inspection during the site visit (see recommendations). The manager stated the plan was not available in written form but that the home follows both the company’s infection control procedures and also guidance from the Department of Health about infection control in care homes. Hand sanitizers with liquid gel are sited at key points around the home. The disinfectors in each of the three sluice rooms were said to be in good working order. The laundry has one machine for washing soiled laundry placed in soluble bags and another for washing laundry that has not been soiled. The laundry was clean and reasonably tidy when inspected, with all machines working satisfactorily. A communal bathroom on the third floor had a pedal bin that was not working in that the lid failed to open when the pedal was pressed. This meant that anyone using the bin had to touch the lid in order to open it. This was drawn to the attention of the nurse in charge so she could arrange for repair or replacement of the bin. The home’s clinical waste bins had locks, the lids were shut, and the external area where the bins were being kept was tidy. In May 2009, the water authority inspected the home and identified noncompliance with the Water Regulations. The manager stated that contractors have quoted for the major works that need to be done and that the home’s maintenance technician has already carried out some of the minor works Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 21 needed. The inspector was satisfied standard 26 will be fully met once all the works required by the water authority have been completed. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The levels and skill mix of nursing and care staff were sufficient to meet residents’ needs, though it is recommended cleaning staff levels be reviewed. The recruitment procedures operated by the home are robust, and support and protect residents. New staff members have inductions that prepare them for their work in the home and all staff have access to relevant training. EVIDENCE: On the first morning of this unannounced inspection visit, there were two qualified nurses and five carers on duty, providing care to the twenty-seven people in residence. Examination of rotas showed that care staff levels and skill mix had been consistent. Two of the six residents who responded to our survey stated staff are always available when they need them, with four stating this is usually the case. Of the three staff members who replied to our survey, one stated there are always enough staff to meet residents individual needs, with two stating this is usually the case. Discussions with staff members during the inspection showed they thought there are enough staff on duty and that staff work well as a team. More permanent care staff had been recruited to ensure Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 23 consistency of care and the manager stated since October 2008 the home had only used agency staff for one day to cover staff attendance at an important training event. It was apparent that the levels of cleaning staff could be improved. The home has a hospitality manager and two cleaning staff, one of whom was off sick at the time of inspection (see recommendations). All of the staff members who responded to our survey and those staff interviewed during the inspection visit confirmed their employer had carried out checks, such as references and Criminal Records Bureau disclosures, before they started work in the home. The home’s AQAA confirmed an equal opportunities policy is followed in relation to recruitment and selection of staff. The registered manager and the company’s area manager said they are planning to involve residents in the selection of staff from people who apply to work in the home. Two of the three staff members who responded to our survey stated their induction had covered everything very well what they needed to know to do the job when they started, and one stated the induction had mostly covered everything. All of these three staff members stated they were being given training that is relevant to their role. Two stated this training helps them understand and meet peoples individual needs, keeps them up to date with new ways of working, and gives them enough knowledge about health care and medication, but one stated the training does not do this. Staff members spoken with during the inspection were positive about their training, and said much is now delivered as e-learning which means they can also undertake some training activity at home on their computers. They confirmed their mandatory training was up to date. Five of the six residents who responded to our survey stated staff always listen to them and act on what they say, and one resident stated staff usually do this. The health care professional responding to our survey stated that the homes manager and staff always have the right skills and experience to support peoples social and health care needs. The inspector was shown the training matrix on-line, supplemented by written information for June 2009. This shows the provider monitors continuously to make sure that mandatory training, including adult protection, is completed. The inspector advised the manager that, as well as evidence of training input, it is important that the home is able to provide evidence of the effectiveness of training that has been undertaken, in terms of the outcomes for people using the service. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 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. Residents and their representatives can be assured the registered manager has the skills and experience needed to run a care home that provides nursing care, and that the home is being managed well. People’s views are taken into account when the home assures the quality of its services. Residents’ financial interests are safeguarded. Arrangements for the formal supervision of staff are improving but more remains to be done in this respect. The home makes good effort to promote the health and safety of its residents, staff and visitors, though there are some specific aspects to address. EVIDENCE: Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 25 It was evident the home is being managed well. The manager of Sundridge Court is an experienced nurse and has previously been the registered manager of a care home. The company has a regional manager who is contactable by the home manager at all times, and the regional manager was present on both days of the inspection. The manager walks around the home each day to speak with residents and staff, and is readily available to meet with relatives or other representatives to discuss any matters they wish to raise. The manager distributes a quarterly newsletter, and copies of the most recent edition (June 2009) were available in the reception area. This edition of the newsletter offered helpful information to residents, their relatives and friends, for example, about refurbishment in the home and about forthcoming events such as the summer barbeque. The annual quality assurance assessment (AQAA) provided to us by the home’s manager was clear and contained relevant information. The AQAA told us about changes made and also identified where the home still needs to make improvements. The home has strategies to assure the quality of its services, in which the views of residents, their representatives and staff members are taken into account. The home’s regulation 26 file that was seen during the inspection showed that visits had been undertaken each month and reports produced. The manager holds client/resident meetings with the most recent for which the minutes were available being in March 2009. Seven residents and nine relatives had attended and various aspects of service provision had been discussed. As we had seen at our last inspection, the “Annual Service User Questionnaire Feedback” for August 2008 gave a summary of responses to questionnaires sent by the home to residents. It was understood a similar report for 2009 would be available later in the year. An internal audit carried out by the provider in March 2009 had concluded that overall the home was performing well. The home makes sure residents’ financial interests are safeguarded. Money that residents have asked the home to look after for them is kept under lock and key in a room that is locked when unoccupied. The home’s administrator said the use of a safe had been raised with senior management. There are regular internal audits to monitor the home’s management of residents’ money. During the inspection visit, three residents’ records were selected at random, checked against monies held and all were found to be satisfactory. Brief notes from two staff meetings were made available for inspection. Seven staff including the manager and deputy manager had attended the most recent meeting in June 2009, when various matters to do with the day to day running of the home had been discussed. The staff members responding to our survey were asked whether the manager gives them enough support and meets them to discuss how they are working. One stated this happens regularly, another that it happens often and the third stated this never happens. Staff members Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 26 spoken with during the inspection felt supported by senior staff, although they did not confirm they have formal supervision at the intervals set out in the standard. One commented that a senior will sometimes sit down to speak with her “but that doesn’t really happen often unless they’ve got something to discuss with you, like about a new resident coming in”. Thus, it was not possible to conclude that our previous recommendation about the frequency of formal supervision for care staff has yet been fully met (see recommendations). It was evident that the home promotes the health and safety of its residents, staff and visitors, though it was also noted on the second day of the inspection that there were three specific aspects needing improvement (see requirements). Each of these issues was discussed while giving feedback to the registered manager and the area manager, so prompt action could be taken. A resident was sitting in the lounge in a wheelchair with another resident’s name on it and without footplates. The resident had been moved from her bedroom to the lounge in this chair. Two wheelchairs being stored outside room 26 did not have footplates. A carer said “they must have fallen off again and not been put back on, I’ll have to go around and check”. It is important that footplates are always used on wheelchairs, to help prevent injury to residents. A cleaning trolley with potentially hazardous (COSHH) products was seen unattended in a communal bathroom. The external bolt on the bathroom door had been closed but was easy to open. It was understood staff had left the trolley while going for a break, rather than locking it in the room used to store the cleaning products. The cleaning trolley was moved promptly once the inspector drew attention to it. The manager was asked to remind staff not to leave COSHH products unattended, as to do so may present unnecessary risks to residents’ safety. Free-standing, portable fans to cool the temperature were in use in some communal areas, for example the corridor by the lift door on the upper floor. Although these contribute to maintaining a comfortable temperature on this floor, they must be risk assessed in respect of people’s safety. From discussions and from documentation sampled for inspection, health and safety checks were up to date. The fire authority had visited the home in March 2009, and it was evident that the home has fire safety measures in place. In June 2009, the home had received a visit from the local environmental health service to carry out a food hygiene inspection. The home was awarded a 5 star Foods Standards Agency rating, which is a commendable achievement. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 2 Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Timescale for action 31/10/09 2 OP38 13 3 OP38 13 4 OP38 13 The registered person must ensure the home is in compliance with the relevant legislation, which requires they have a controlled drugs cupboard of the appropriate design that is installed correctly. The registered person must 31/08/09 ensure wheelchairs have footplates and that these are always used, to prevent injury to residents. The registered person must 31/08/09 ensure that portable fans are risk assessed in respect of people’s safety. The registered person must 31/08/09 ensure staff do not leave cleaning products unattended, as to do so may present unnecessary risks to residents’ safety. Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP12 OP26 OP27 OP36 Good Practice Recommendations The registered person should ensure the recording of activities is improved, with more evaluative comment to show outcomes. The registered person should ensure the home’s action plan for infection control is available for inspection as required. The registered person should ensure cleaning staff levels are reviewed and increased as necessary. The registered person should ensure care staff receive formal supervision at least six times each year. (This is now in progress and is restated to ensure the improvement is carried through to completion). Sundridge Court Nursing Home DS0000010144.V376233.R01.S.doc Version 5.2 Page 30 Care Quality Commission 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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