Care Home: Sunningdale Nursing Home

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What the care home does well Sunningdale presented as a well maintained and homely environment. The management and staff team were observed to be attentive to the needs of the people living in the home and residents spoken with were generally complimentary of the standard of care provided. For example, comments received from four residents included: “They look after my healthcare needs very well”; “If I need anything I get it”; “I find the manager and staff team very kind and helpful” and “I have always been very well cared for and I am happy here.” A relative spoken with described the standard of care as “Excellent”. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.2 Information on the service provided at Sunningdale was available in the form of a Service User Guide and a small leaflet. A new website had also been developed since the last inspection, which included pictures of the home and links to relevant information. Assessment and care planning systems had been developed to identify and manage the needs of the people using the service and examination of medical records and discussion with residents confirmed people had access to health care professionals subject to individual need. Residents spoken with confirmed they were able to follow their preferred routines and receive visitors throughout the day. A programme of in-house and community based activities had been developed by the home’s dedicated activities coordinator and residents had access to a choice of meals that provided a wholesome and nutritious diet. Comments regarding the meals included: “The standard of catering is good”; “Overall I enjoy the meals and there are other choices on offer” and “I have no complaints about the food here.” Policies and procedures had been established to ensure an appropriate response to complaints and suspicion or evidence of abuse. Furthermore, systems were in place to monitor and obtain feedback on the quality of the service, to ensure it is run in the best interest of residents. Residents spoken with confirmed that they felt safe living in Sunningdale and that their views were listened to. Sufficient numbers of staff were in place and systems had been established to ensure staff were correctly recruited and have access to induction and ongoing training. Feedback received from staff was positive and confirmed staff were valued and supported in their roles. For example, comments included “I have worked here may years and have always been happy in my employment”; “I think the home looks after the needs of residents very well” and “I enjoy working at Sunningdale it is a nice friendly place to work. The staff and the manager are really good people. We can work as a good team. Our manager is very good and considers everybody’s feelings and interests.” What has improved since the last inspection? Since the last inspection, action had been taken to address the recommendations made in the last report. A copy of the most local authority’s most recent adult protection procedures had been obtained for staff to reference.Sunningdale Nursing HomeDS0000017257.V378166.R01.S.docVersion 5.2A bathroom floor had been re-sealed to minimise the risk of a trip hazard to residents. A new system had been introduced for the segregation of foul and clean linen to improve infection control procedures. The Registered Provider had also continued to invest money into Sunningdale to maintain a safe, homely and comfortable environment for residents. What the care home could do better: Staff responsible for handling and receiving medication into Sunningdale should undergo a competency assessment periodically. This will help to maintain a clear audit trail and safeguard the welfare of the people using the service. A log of complaints received should be established. This will help to provide a clear record of any complaints received and action taken. The capacity of staff should be recorded on the staffing rota to clarify the individual roles of staff. The staff training matrix and individual training records should be updated to provide a clear overview of the range of training completed by staff and any outstanding training needs. Routine testing of the fire alarm system and other equipment in the home should be closely monitored by the management team to safeguard the welfare of the people using the service. Key inspection report CARE HOMES FOR OLDER PEOPLE Sunningdale Nursing Home 7 - 9 Albany Road Southport Merseyside PR9 0JE Lead Inspector Daniel Hamilton Key Unannounced Inspection 23rd October 2009 09:45 DS0000017257.V378166.R01.S.do c 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 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. Sunningdale Nursing Home DS0000017257.V378166.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 Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunningdale Nursing Home Address 7 - 9 Albany Road Southport Merseyside PR9 0JE 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) 01704 538568 01704 543891 sunningdalenursinghome@yahoo.co.uk www.sunningdalenursinghome.com Mrs Patricia Jane Bennett Mrs Gaye Clark Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 32 OP This service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. May from time to time admit persons between the ages of 60 and 65 years of age. Service to include 1 named SU within the PD category Date of last inspection 20th October 2006 Brief Description of the Service: Sunningdale is a large detached building that provides nursing care for 32 older people. Mrs Patricia Jane Bennett privately owns Sunningdale and it is managed by Mrs Mrs Gaye Clark. Sunningdale is situated within a short walk to Southport town centre and local amenities are close by. The home has 30 single rooms and 1 double room and some have ensuite facilities. The accommodation is situated over 4 floors and a passenger lift is used to access all areas. The conservatory on the ground floor used as lounge and dining area. There is also a separate dining room. Sunningdale has wheelchair access via a ramp to the side of the building and residents benefit from an attractive landscaped garden. The home has suitably adapted baths and a walk in shower to assist those who are less able. A call system is available throughout the premises. Mrs Patricia Jane Bennett privately owns Sunningdale and it is managed by Mrs Mrs Gaye Clark. The weekly fee rate for accommodation is £525.00. Sunningdale Nursing Home DS0000017257.V378166.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 3 star. This means that the people who use the service experience excellent quality outcomes. The inspection took place over one day and lasted approximately eight hours. Thirty residents were being accommodated at this time. A site visit took place as part of the unannounced inspection and a partial tour was conducted of the premises. A number of the home’s care, staff and health and safety records were viewed. Discussions also took place with the owner, registered manager, clinical lead nurse, four staff, a relative and seven residents. During the inspection three residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. Reference was also made to an Annual Quality Assurance Assessment (AQAA) which was completed by the registered manager. This document enables a registered person to undertake a self-assessment on the service, prior to an inspection. Survey forms were also distributed to a number of residents and staff before the inspection. Comments included in the report are taken from the survey forms and through discussions with residents during the site visit. All the key standards were inspected and action taken in response to recommendations made at the last inspection in November 2006 was reviewed. What the service does well: Sunningdale presented as a well maintained and homely environment. The management and staff team were observed to be attentive to the needs of the people living in the home and residents spoken with were generally complimentary of the standard of care provided. For example, comments received from four residents included: “They look after my healthcare needs very well”; “If I need anything I get it”; “I find the manager and staff team very kind and helpful” and “I have always been very well cared for and I am happy here.” A relative spoken with described the standard of care as “Excellent”. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.2 Page 6 Information on the service provided at Sunningdale was available in the form of a Service User Guide and a small leaflet. A new website had also been developed since the last inspection, which included pictures of the home and links to relevant information. Assessment and care planning systems had been developed to identify and manage the needs of the people using the service and examination of medical records and discussion with residents confirmed people had access to health care professionals subject to individual need. Residents spoken with confirmed they were able to follow their preferred routines and receive visitors throughout the day. A programme of in-house and community based activities had been developed by the home’s dedicated activities coordinator and residents had access to a choice of meals that provided a wholesome and nutritious diet. Comments regarding the meals included: “The standard of catering is good”; “Overall I enjoy the meals and there are other choices on offer” and “I have no complaints about the food here.” Policies and procedures had been established to ensure an appropriate response to complaints and suspicion or evidence of abuse. Furthermore, systems were in place to monitor and obtain feedback on the quality of the service, to ensure it is run in the best interest of residents. Residents spoken with confirmed that they felt safe living in Sunningdale and that their views were listened to. Sufficient numbers of staff were in place and systems had been established to ensure staff were correctly recruited and have access to induction and ongoing training. Feedback received from staff was positive and confirmed staff were valued and supported in their roles. For example, comments included “I have worked here may years and have always been happy in my employment”; “I think the home looks after the needs of residents very well” and “I enjoy working at Sunningdale it is a nice friendly place to work. The staff and the manager are really good people. We can work as a good team. Our manager is very good and considers everybody’s feelings and interests.” What has improved since the last inspection? Since the last inspection, action had been taken to address the recommendations made in the last report. A copy of the most local authority’s most recent adult protection procedures had been obtained for staff to reference. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.2 Page 7 A bathroom floor had been re-sealed to minimise the risk of a trip hazard to residents. A new system had been introduced for the segregation of foul and clean linen to improve infection control procedures. The Registered Provider had also continued to invest money into Sunningdale to maintain a safe, homely and comfortable environment for residents. 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. Sunningdale Nursing Home DS0000017257.V378166.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 Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 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, 3 and 6 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before deciding whether to move into Sunningdale. This enables the service to identify needs and to determine whether care needs can be met. EVIDENCE: A variety of information on Sunningdale was displayed on a welcome desk in the main hallway. This included a copy of the Statement of Purpose / Service User Guide and the latest inspection report from the Care Quality Commission. At the time of the visit the Service User Guide needed to be updated to include a copy of the fire precautions and associated emergency procedures and this was immediately addressed by the Registered Manager. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 10 Residents spoken with during the visit confirmed they had received information on the home and its philosophy of care via a Service User Guide and a small leaflet. There were also brochures on community services available to the residents and the notice board had staff photographs on it, to help residents to identify staff as previously noted. The Annual Quality Assurance Assessment detailed that a new website had been developed since the last inspection, which included pictures of the home and links to relevant information. The files of three permanent residents who had moved into Sunningdale since the last inspection were viewed during the visit. Each file was found to contain a comprehensive assessment of need which had been undertaken by the manager or a qualified member of the staff team. Assessments viewed covered a range of areas including: background information, medical conditions, current medication, allergies, aches / pains, pain relief, observations, dietary requirements, vision, hearing, mouth care, foot care, orientation, mobility, mobilising, eating and drinking, communication, skin and physical conditions, elimination, working and playing and mental health. It was not possible to verify that the assessments had been completed prior to admission as the assessments were not dated and information on ethnicity had not been included. The Commission received confirmation, following completion of the inspection, that assessment documents had been updated to include this key information. Evidence of assessment information from social services and also transfer letters from hospital to assist the home with collating the assessment information had been obtained. Standard 6 is a key standard to be assessed however was not applicable as the home does not provide intermediate care. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 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 and 10 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 health and personal care of the people living in Sunningdale is effectively managed and coordinated so people receive appropriate care and support. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) for Sunningdale detailed that the service had a policy in place on ‘Individual Planning and Review’ and the ‘Control, Storage, Disposal, Recording and Administration of Medicines’. The files of three permanent residents who had moved into Sunningdale since the last inspection were viewed during the visit as part of a case tracking process. Each file was found to contain a care plan that outlined ‘Needs /Problems’, ‘Goal of Nursing / Desired Outcome’ and ‘Nursing Plan’. A plan of care had been developed for key areas identified at the assessment stage and evidence of monthly reviews had been maintained. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 12 Staff spoken with demonstrated an awareness of the care plans, needs of residents they cared for and a commitment to providing person-centred care. Advice was given to the Registered Manager on terminology used and how to improve the care plan review processes and obtain confirmation that plans had been developed and / or agreed in consultation with residents or their representatives (where practicable). The Commission received confirmation, following completion of the inspection that care plan documents had been updated and review systems improved as recommended during the visit. Files also contained evidence of risk assessments, wound assessments and photographs, ‘TPR’ (observation) and weight records, incident charts, medical notes, diary sheets and other general correspondence and documents. Feedback received from residents and their representatives via Care Home Survey forms and through discussion confirmed the people living in the home received the medical support they required. Medical records viewed provided evidence that residents had attended hospital appointments and accessed other health care practitioners including general practitioners, dentists, chiropodists and opticians subject to individual need. Medication was dispensed by a local pharmacist via a blister pack system. Medicines were administered from a medicine trolley that was stored within a cupboard via a chain when not in use. Separate storage and recording facilities were in place for controlled drugs. At the time of the visit none of the residents self-administered medication. A system had been established to help staff correctly identify residents prior to administering medication and a record of staff designated with responsibility for administering medication and sample signatures was in place for reference. On the day of the inspection the medicine trolley was found to be clean and organised. A number of Medication Administration Records (MAR) were viewed during the visit and these evidenced a staff signature following administration of medicines. It was noted that none of the MAR viewed provided an audit trail for medication as details of the amount of medication received, date and person receiving / checking medication into Sunningdale had not been recorded. Furthermore, one MAR with handwritten entries had not been countersigned to confirm that each prescribed instruction had been correctly recorded as per the original prescription. Separate records had been established to record audit information however the name of the person receiving / checking medication into Sunningdale had not been recorded as noted above. The Registered Manager reported that this was not common practice and that the omission had occurred as a result of another Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 13 staff member checking in medication on behalf of a colleague who was on holiday. Examination of MAR charts for previous months confirmed that medication audit records were correctly maintained. Staff spoken with during the visit demonstrated an awareness of the principles of best care practice and feedback received from residents and their representatives regarding the standard of care was positive. Comments from residents included: “They look after my healthcare needs very well”; “If I need anything I get it”; “I find the manager and staff team very kind and helpful” and “I have always been very well cared for and I am happy here.” A relative spoken with described the standard of care as “Excellent”. One resident spoken with expressed concern regarding the length of time staff sometimes take to respond to the call bell. This issue should be closely monitored and action taken if necessary. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 14 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 and 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are well managed and provide daily variation and interest for people living in Sunningdale. EVIDENCE: Sunningdale has a dedicated Activities Coordinator who works three days per week (Wednesday to Friday) to organise a range of activities for residents. Furthermore, on a Monday a hairdresser visits the home and on a Tuesday a pianist is on-site. Discussion with residents and examination of records confirmed that a range of activities was provided that were based upon each resident’s abilities and preferences. Feedback from the majority of residents confirmed they were satisfied with the range and frequency of activities provided and were complimentary of the activities coordinator. The Annual Quality Assurance Assessment (AQAA) for the service detailed that activities were designed to encourage mental alertness, self-esteem and social Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 15 interaction. Residents who preferred not to join in group activities confirmed their wishes were respected. A programme of activities was displayed on a large whiteboard outside the main office and community based activities are also organised periodically e.g. shopping trips, group outings, trips to the pub etc. Residents spoken with reported that they had participated in bingo, card games, quizzes, memory card games, clothing parties, chair exercises and birthday parties etc. One resident reported that a barbeque was organised during the summer and another advised that a trip to see the Blackpool illuminations had been organised and that events for the Christmas period were being planned. Two residents also used the service of ‘Link Line’ – a specially adapted vehicle that can be hired to access the wider community. A daily record had been completed for each resident regarding their involvement with the social programme and whether they enjoyed the sessions and a social and recreational profile was available on individual files. Representatives from three different denominations continued to visit Sunningdale each month, to offer spiritual input for residents subject to individual needs. Sunningdale had a four-week rolling menu in place and a selection of alternative special meal options had been produced. The Registered Manager confirmed that the service would cater for the health, religious or cultural dietary needs of prospective and current residents as required. For example, at the time of the visit the service was providing soft / puree meals for some residents. The AQAA detailed that the kitchen staff were appropriately qualified and confirmed that the service had maintained a 5 star ‘Scores on the doors’ rating. Menus viewed provided evidence that residents received a wholesome and nutritious diet. At the time of the inspection individual records of dietary intake had not been maintained and the Registered Manager was recommended to record this information to ensure best practice. Meals were served in the dining room which was pleasant and comfortable and meal-times were observed as being a sociable event for the residents. A number of residents had their lunch on coffee tables in the conservatory or in their own rooms. Staff were observed to be available to offer support during meal times as required and feedback received from residents was positive about the standard of catering. Comments included: “The standard of catering is good”; “Overall I enjoy the meals and there are other choices on offer” and “I have no complaints about the food here.” Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 16 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 and 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. Systems are in place to ensure the people who live in Sunningdale understand how to complain and are protected from abuse. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) for Sunningdale detailed that a concerns and complaints policy was in place as noted at the last inspection. A copy of the procedure was displayed on the notice board in the reception area and details were also in the Service User Guide, a copy of which is given to residents and / or their personal representative upon admission to the home. The AQAA detailed that the service had received one complaint in the last 12 months. The complaint was referred to the Provider by the Care Quality Commission and following an investigation was not upheld. No complaints or concerns were raised by residents or their representatives during the inspection process. At the time of the visit a log of complaints received was not available for inspection. The Registered Manager was requested to ensure a record was established for reference, as was found to be in place at the last inspection. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 17 Feedback received via care home surveys and discussion confirmed the majority of residents using the service and their representatives were aware of how to complain and the location of the complaints procedure. Residents spoken with also confirmed that they felt safe living in Sunningdale and that their views were listened to. A copy of the local authority’s adult protection procedures together with internal policies on abuse and whistle-blowing were available for staff to reference. The AQAA detailed that all staff receive ongoing training on abuse and whistle-blowing focusing on the various types of abuse and the handling of suspected or alleged abuse. The manager and staff spoken with during the visit demonstrated an awareness of their duty of care to protect the welfare of the people using the service and how to recognise and respond to suspicion or evidence of abuse. Staff also confirmed that they had completed training in the protection of vulnerable adults. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 18 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 and 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. Sunningdale provides a safe and comfortable environment for residents who benefit from homely, comfortable and well-maintained surroundings. EVIDENCE: Sunningdale continues to provide very comfortable accommodation as noted at the last inspection and was found to be well maintained and homely. The Registered Manager reported that a maintenance man and contractors were hired as and when necessary and a maintenance book was available to record work in need of attention. An annual development plan was also in place which included maintenance targets. The AQAA detailed that in the last 12 months the premises had continued to receive ongoing investment and maintenance. For example; the building Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 19 exterior and conservatory had been repainted to include the boundary walls and metal gates; 8 bedrooms and 3 bathrooms had been redecorated and new bathroom fixtures installed; a shower had been replaced and hand sanitizers and first aid boxes had been installed in key areas to improve infection control and health and safety; digital aerials had been fitted to all areas of the home in readiness for the switch over; the sluice on the second floor had been replaced and all sluice areas had been fully enclosed; the clinical area had also been redesigned to provide lockable medical storage to fully enclose the new medicine cabinet and clinical supplies, garden furniture and parasols have been purchased for the benefit of residents. Action had also been taken to re-seal a bathroom floor to minimise the risk of a trip hazard to residents as previously recommended. On the day of the inspection the home was found to be very tidy, clean and hygienic and residents spoken with confirmed they were happy with the standard of the environment and reported that their rooms were cleaned each day. For example, one resident reported; “We have a very good cleaner and housekeeper”. Bedrooms seen were pleasantly decorated and furnished and had been personalised with pictures, memorabilia and furniture. (Please refer to the ‘Brief Description of the Service’ section for more information on the premises). The AQAA detailed that the home employs a housekeeper and a domestic and confirmed the majority of the staff had completed infection control training. The housekeeper was spoken with during the visit and confirmed she had completed key training relevant to her role and that staff had access to supplies of gloves and aprons to ensure good hygiene and infection control. Although the laundry room is small, laundry is managed efficiently and personal items continue to be stored in individual baskets to prevent loss. Since the last inspection a new system has been introduced as recommended at the last inspection to segregate clean and foul linen. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 20 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 and 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. Sufficient numbers of staff are in place and systems have been established to ensure staff are correctly recruited and have access to induction and ongoing training. This helps to develop staff competence and safeguard the welfare of vulnerable adults. EVIDENCE: At the time of the visit thirty residents were living in Sunningdale. Examination of the staffing rota and discussion with the Registered Manager and staff confirmed a registered nurse and six care assistants are on duty from 8.00 am until 5.00 pm. From 6.00 pm until 8.00 pm a registered nurse and 5 care staff are on duty. During the night a registered nurse and two members of care staff are on duty. The gender mix of staff was noted to be good and on the day of the inspection two male care assistants were on duty. This enables residents to choose whether they wish to be assisted by a male or female staff member. Ancillary staff are also employed for laundry, kitchen, housekeeping and maintenance roles and the home continued to provide training experience for student nurses. The registered manager was requested to update the rota to include the capacity of each staff members as this information was recorded. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 21 The permanent staff continue to cover sickness and holidays and agency staff are therefore seldom used. At the time of the visit 23 care staff were employed to work a Sunningdale. Records detailed that 13 staff (56.52 ) had completed a National Vocational Qualification (NVQ) at level 2 or above in Care. The Annual Quality Assurance Assessment (AQAA) detailed that the service has a policy on recruitment as noted at the last inspection. The personnel files of three staff (a registered nurse, and two care assistants) that had commenced employment since the last inspection were selected to view. Each file contained a copy of an application form, health questionnaire, two references from previous employers, confirmation of the outcome of Protection of Vulnerable Adult (POVA) and Criminal Record Bureau (CRB) enhanced checks, photographs and recruitment records. In the case of a registered nurse, evidence of registration with the nursing and midwifery (NMC) was also available for reference. Records were well maintained and provided evidence of sound recruitment practice that safeguarded the welfare of vulnerable people. Files viewed for care assistants contained evidence of Skills for Care induction training, however some sections of one progress log had not been signed and a certificate of completion was not on file. Furthermore, there was no evidence of induction for a registered nurse. The Commission received confirmation, following completion of the inspection, that the registered nurse had received induction training. Staff spoken with confirmed they had received induction training and copies of key policies and procedures upon commencement of their employment at Sunningdale. At the time of the visit the training matrix was not up-to-date and the annual planner did not provide evidence of all safe working practice training. Likewise, some training records were not up-to-date. These issues should be addressed to provide a clear overview of training completed. Despite the absence of some key information staff spoken with were complimentary of the range and standard of training and development opportunities they had access to. Staff confirmed they had completed safe working practice including moving and handling, infection control, food hygiene, first aid and other training relevant to the needs of the people they cared for e.g. palliative care, continence promotion, abuse, national vocational qualifications etc. Documentary evidence of training was available on files viewed and staff reported that they had access to supervisions and annual appraisals. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 22 Comments from three staff included: “I have worked here may years and have always been happy in my employment”; “I think the home looks after the needs of residents very well” and “I enjoy working at Sunningdale it is a nice friendly place to work. The staff and the manager are really good people. We can work as a good team. Our manager is very good and considers everybody’s feelings and interests.” Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 23 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, 33, 35 and 38 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration systems have been established, to ensure Sunningdale operates in the best interest of the people using the service. EVIDENCE: Since the last inspection, the former Registered Manager of Sunningdale Mrs Jane Williams has left and a new manager Mrs Gaye Clark has registered as the manager of the service with the Care Quality Commission. Mrs Clark has worked at Sunningdale since 1987 and has held a variety of roles before becoming the Registered Manager. Mrs Clarke has completed the level 5 National Vocational Qualification (NVQ) in Management and a level 4 Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 24 NVQ Registered Manager’s Award. Mrs Clark was recommended to undertake a NVQ 4 in Health and / or Social Care to ensure she has the necessary qualifications for her role. Training records also confirmed that Mrs Clark has completed other training relevant to her role including; safe working practice training, dementia, managing violence, wound care, staff supervision, abuse, activities management and Mental Capacity Act etc. Mrs Clark is not a Registered Nurse and therefore she is supported in her role by Mrs Anne Harrison (a Registered Nurse who leads on clinical issues). Mrs Clark and Mrs Harrison work closely together regarding staff supervision, training requirements, general administration and also reviewing policies and procedures. The management structure is organised and there are also heads of department for the kitchen and housekeeping team as previously noted. Residents and staff spoken with confirmed the Registered Manager was approachable, open and transparent in her management style and Mrs Clark demonstrated a commitment to the ongoing development of the service. For example, comments from two staff included: “Gaye has been doing really well, is supportive and I am sure she will continue to do so” and “The home is generally well run.” Likewise, a resident reported “The manager takes a genuine interest in the welfare of everyone here.” Prior to the inspection the Registered Manager completed an Annual Quality Assurance Assessment (AQAA). The document was received within the required timescale and was clear, detailed and informative. During the visit the Registered Provider (Mrs Bennett) was observed to visit the home. Discussion with the management team, staff and residents confirmed Mrs Bennett visited the home frequently each week to monitor standards and offer support. Evidence that monthly reports had been completed in accordance with Regulation 26 of the Care Home Regulations were on file however the manager was unable to locate the most recent reports at the time of the visit and agreed to address this. The Registered Provider continued to commission an external consultant to undertake an annual quality assurance assessment. This was last completed during May 2009. Surveys are also distributed to residents, relatives and staff on an annual basis to obtain feedback on the quality of the service from stakeholders. Management and staff meetings are coordinated periodically as previously noted, although the last quality circle review forum meeting was coordinated in February 2008 due to the dependency levels of residents. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 25 Staff supervision was not assessed however it was noted that staff receive this and also an annual appraisal. The home has a good range of policies and procedures. An external company on a regular basis updates these. The AQAA for the service detailed that policies and procedures on the Management of Service Users’ Money, Valuables and Financial Affairs had been developed. The Registered Manager reported that residents are encouraged to manage their own monies or personal allowances independently or with support from families or personal representatives. At the time of the visit the Registered Provider was acting as an appointee for one resident and the Registered Manager looked after the resident’s personal allowance. Systems are in place to ensure financial transactions are recorded and to obtain receipts should a resident(s) require support with managing their money. Other personal expenditure is logged and re-claimed periodically. Examination of the AQAA confirmed that Health and Safety policies and procedures together with test, maintenance and /or associated records were in place and up-to-date for all key areas. Fire log and service records were checked during the visit. Fire log records viewed confirmed that the fire alarm system had generally been tested on a weekly basis however some minor gaps were noted. Furthermore, records viewed highlighted some gaps in the testing of emergency lighting each month. Evidence of a maintenance certificate for the fire extinguishers was in place however this had not been correctly dated by the contractor and a certificate to confirm the fire detection and alarm system could not be located. The Commission received confirmation following completion of the inspection that action had been taken to address the issues together with up-to-date copies of service certificates. A fire and building risk assessment of the premises was found to be in place.. Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 4 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 4 4 X 3 X X 3 Sunningdale Nursing Home DS0000017257.V378166.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Staff responsible for handling and receiving medication into Sunningdale should undergo a competency assessment periodically. This will help to maintain a clear audit trail and safeguard the welfare of the people using the service. A log of complaints received should be established. This will help to provide a clear record of any complaints received and action taken. The capacity of staff should be recorded on the staffing rota to clarify the individual roles of staff. The staff training matrix and individual training records should be updated to provide a clear overview of the range of training completed by staff and any outstanding training needs. Routine testing of the fire alarm system and other equipment in the home should be closely monitored by the management team to safeguard the welfare of the people DS0000017257.V378166.R01.S.doc Version 5.3 Page 28 2 3 4 OP16 OP27 OP30 5 OP38 Sunningdale Nursing Home using the service. Sunningdale Nursing Home DS0000017257.V378166.R01.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. 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