Care Home: Sunnydale

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What the care home does well People living in Sunnydale are receiving support from experienced and trained staff. They are being provided with a stable, structured home environment that helps them to maintain their existing level of independence and independent living skills. They are assisted to develop their potential for increased independence at a realistic pace in line with their own wishes and their changing health. What has improved since the last inspection? The previous inspection of Sunnydale took place before many people had been admitted. The current inspection is therefore the first real opportunity to establish any kind of `benchmark` for the standard of care being experienced. This can then be used to monitor the standard of care provision in the ongoing regulation of this service. What the care home could do better: The management of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Sunnydale 32 Shrewsbury Road Craven Arms Shropshire SY7 9PY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pat Scott     Date: 1 6 0 9 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 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 Adults (18-65 years) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Sunnydale 32 Shrewsbury Road Craven Arms Shropshire SY7 9PY 07802514240 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lyndale (Hereford] Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 10. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder (MD) 10 Date of last inspection Brief description of the care home Sunnydale aims to offer a supportive environment, to enable people to gain or regain skills and to recover the confidence necessary for them to be able to move on and live even more independently within the community. The home is situated in the rural village of Craven Arms with accommodation over two floors, including communal areas and office provision for staff. The home has a small rear garden which is accessible to people. There is limited parking available to the front and rear of the home with additional nearby on street parking. There are good local public transport links and local shops. The home has a statement of purpose and service user guide. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 10 1 6 1 0 2 0 0 8 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Although this is the second key inspection for Sunnydale since it was first registered in 2008, it is the first inspection carried out following the admission of the current people using the service. This inspection site visit provided an opportunity for an expert by experience to discuss the move into Sunnydale with them, and to find out how their developing care needs are now being met, together with their plans for the future. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector, to help them get a picture of what it is like to live in, or use the service. This report also draws on information received from the home in their Annual Quality Assurance Assessment (AQAA), which is a self-assessment process that requires care services to record how well care outcomes for the people living in their service are Care Homes for Adults (18-65 years) Page 5 of 25 being met as well as providing a range of statistical information about the service. We also looked at information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service which would affect the well being of a person. These are incidents such as, accidents, medication errors, outbreaks of infectious disease and any deaths, these are called notifications and are a legal requirement. The previous key inspection outcomes and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organizations and what other people have told us about the service. Staff working at the home were interviewed and records were reviewed. Care plans were reviewed of two people spoken to (case tracking). A tour of the premises was made. The manager was available throughout the day to answer any questions. One Regulatory Inspector carried out this inspection over one day. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about Sunnydale is made readily available to help people make an informed choice about whether the home is able to meet their individual needs. Evidence: The manager stated that people are assisted to play an active part in choosing where they would like to live. This is achieved by the individual coming to look at the home prior to possibly moving in. The service has a comprehensive brochure and newsletter that gives the person and their families the opportunity to read about the home. They also receive a service user guide explaining more about the running of the home. A review of files shows that staff compile an individual care plan to suit the persons needs. This states the present care needs and future care needs to help the service user progress. Any therapeutic/occupation/education/life skill needs are assessed in the initial assessment and relevant services are accessed. The plan is continuously monitored. Care Homes for Adults (18-65 years) Page 9 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 living at Sunnydale have detailed support plans in place, which inform staff about their individual needs and how they prefer these to be met. Individuals are supported to make decisions about their life because staff actively promote their rights and provide opportunities for them to make choices. People are supported to take measured risks to enable them to lead the lives they wish and maintain their independence as much as possible. Evidence: We looked at the care records held for two people who live at Sunnydale. Both were detailed and covered areas to include peoples personal and health care needs, medication, daily living, leisure opportunities, religion, finance and likes and dislikes. These ensure staff are familiar with the assessed needs of the individuals they support and enable staff to provide the appropriate care and assistance for people. Records sampled show that peoples needs are regularly reviewed with people close to them Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: such as relatives, key worker, social worker and mental health professionals. We spoke with two staff about the individuals we case tracked and they demonstrated a good knowledge of peoples individual needs, which was consistent with the information held on their care files. Throughout our visit staff were able to interpret peoples communication needs well and were seen to support them with making decisions, for example choosing their activities, meals and refreshments. Advocates, relatives and designated key workers represent peoples best interests. Both care files seen contained risk assessments covering areas to include activities, medication and self help skills. These show that people are not stopped from taking risks but that staff have specific guidelines to follow to minimise the risk of harm, while providing individuals with opportunities to lead the lives they want. Care Homes for Adults (18-65 years) Page 11 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this 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 partake in leisure activities which enables individuals to experience a lifestyle that enhances their quality of life. People are able to maintain friendships important to them and are provided with wellpresented meals in accordance with their dietary needs and choice. Evidence: People spoke to the expert by experience about the lifestyles they lead and the activities they enjoy. A number of people have also been supported to go on holiday and one person told us how much they had enjoyed this. The expert by experience noted: There seemed to be little to do by way of activities in the home, which could be a problem for service users who dont feel up to or arent at the time allowed to go out. There is a local college, and also a Local Mind Association in Shrewsbury, both of which might be able to provide tutors/facilitators to run activities in the home. If this Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: idea is tried out, it needs to be borne in mind that people may not attend to begin with, but as long as sessions are provided on a regular and reliable basis, eventually most people will become at least a little curious. Computer classes was one suggestion. The manager had told me that there are plans to free up a laptop for use by service users, so computer classes could be a good place to start with activities in the home. A record of all activities undertaken is available on the files sampled in addition to activities declined. During our visit two people were taken out in the homes car for the afternoon. Others remained at home supported by staff and took part in activities of their choice such as going to the shop, watching TV or household tasks. People living at Sunnydale are supported to maintain relationships that are important to them for example one person told us he was being driven to see his friend. Care records seen evidence routines are flexible in accordance with peoples needs. For example if somebodys feeling unwell they are able to remain in bed, as happened on the day of our visit. Preferences in relation to activities, likes and dislikes are recorded and discussions with staff evidence they have a good understanding of these. People are provided with a healthy diet and staff are aware of their personal preferences and any specific dietary needs. Food provided is generally British which is reflective of the cultural background of the people currently living at the home. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans show that people receive personal healthcare and support by staff in a way that they prefer so that changing, diverse needs can be met. The management of medication provides protection to people who require help with their medication, supporting their continued good health in a dignified way. Evidence: Care plans sampled detail the level of support the individual requires and how they prefer this to be delivered. People were well groomed and dressed in appropriate styles to their age and gender, promoting a positive self-image. Records seen demonstrate peoples health care needs are closely monitored and that individuals are supported to attend routine health appointments to ensure their health needs are met and additional medical support is obtained. Records clearly evidence the home is working with a number of health and social care professionals to maintain optimum health e.g. occupational therapist, counselling, drugs/alcohol misuse team, consultant psychiatrist whos services are employed by the company for advice and consultation. One professional spoken with told us the service seeks appropriate Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: support and advice should clients needs change. People who are prescribed medication are supported by staff who receive training to ensure they are competent to administer medication, promoting their health and wellbeing. Staff sign to confirm that they have read the medication policy and procedure. Records seen evidence that medication reviews are regularly held to ensure individuals are on the correct prescribed medication and dosage required to maintain their health. Staff encourage people to administer their own medication where possible to promote self esteem and self confidence. Care Homes for Adults (18-65 years) Page 15 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are able to recognise if individuals are unhappy with any aspect of the service they receive therefore residents can be confident that their feelings will be recognised and responded to. The home has procedures in place to safeguard people from potential abuse and staff receive training in adult protection and local procedures, ensuring people living at Sunnydale are protected. Evidence: The home has a complaints policy and procedure within the service user guide. All staff working at the home have the relevant criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks including references. Staff files show that adult protection is discussed during induction and supervision and updates are provided. Good interaction is observed between staff and residents. They are relaxed in their company and showed no signs of distress. Care Homes for Adults (18-65 years) Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Sunnydale are provided with a homely, clean and comfortable place to live where they feel safe and secure. Evidence: A resident showed the expert by experience around the home who has the following comments: Upon entering the home, I was immediately struck by the very pleasant physical environment. The home opened last year, and it is obvious that a lot of thought and money has gone into the decor and furnishing. The standard of outfitting conveys a clear sense that service users will be valued. All rooms have en-suite bathrooms. There are 2 lounges; the main lounge with large TV and a smaller lounge (called the sun room) with a portable TV, games console and stereo system. The main lounge has 2 sofas which would seat 6 at a maximum, so if the home was fully occupied and all the service users wanted to sit in the lounge it would be a squeeze. The dining area is furnished with ordinary dining tables and chairs, and the kitchen is also an ordinary looking domestic type kitchen. I observed service users helping staff to prepare lunch. The home has very much a domestic feel all round, and staff appeared to relate to service users in a friendly and respectful way. Staff eat meals with service users, adding to the family feel. Service users have to ask staff to let them in to the kitchen, but the service users I spoke to said that they have never had Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: problems with this, and that they are able to prepare drinks and snacks for themselves. They said that the food is varied and good quality, and that they have a good level of input into the menu. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work positively and receive good training opportunities to equip them with the skills and knowledge to meet the needs of the people they support. People have confidence in the staff at the home because the checks have been done to make sure that they are suitable to care for them. Evidence: The people living at Sunnydale are cared for by a more established team of staff who appear very committed to their work and have a good understanding of individual needs. Discussions held with staff evidence that they enjoy their work, that morale is good and that they function well as a team. Observations made clearly evidence that staff enjoy their work and have developed positive working relationships with the people they support. All new staff have the necessary pre-recruitment checks to ensure people living at the home are safeguarded. The expert by experience spoke with staff and commented: I was given a tour round the home by a service user. We chatted as we went along, and he spoke very highly of the support he has had at the home and how it has helped him move forward. He cleans his own room, does his own laundry, and accesses local facilities independently. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: Service users do not have keys to the front door, but do have keys to their own rooms. I was struck by the high staff to service user ratio. Service users have a named keyworker, but I was told that service users dont have dedicated time set aside to speak to their keyworkers. Sometimes people dont feel like approaching a member of staff to ask for 1-to-1 time, usually when they need it most in my own experience, and so maybe it would be worth staff approaching their service users at the start of each shift to ask if they want some 1-to-1 time, and scheduling this in as required. The staff member I spoke with feels that the home is a positive place to work and very supportive re staff training and development. She said that service users dont really take part in recruitment, but that prospective staff meet the service users during the process. It might be possible for service users to be more actively involved in recruitment, for the company as a whole. The staff member said that she had never attended any training that was delivered by service users, but would be very interested in doing so. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 management systems in place ensure that people living at Sunnydale enjoy a safe and well run service. Evidence: People living at the home benefit from a manager who is experienced and has a clear understanding of their individual needs. The manager is registered with us and has lots of experience in social care and is well supported by a deputy manager and the staff team. The manager has attended training courses relevant to his role. We spoke with staff and they were complimentary about how Sunnydale is managed. Comments include: Russell is a good manager The manager is fair and approachable Russell operates an open door policy; hes very approachable and definitely a good leader The Annual Quality Assurance Assessment (AQAA) forwarded to CQC reflects both the Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: strengths and areas for improvement, which the manager acknowledged at the time of inspection. It was reported that satisfaction surveys are to be developed for residents and others with an interest in the service to ascertain their views in order to help assess how the service is currently performing and aid future planning. Monthly visits required by Regulation 26 are undertaken at the required frequency and detailed reports based on the findings were available for inspection. The home manager works closely with the team to ensure all areas of health and safety are covered and health and safety checks are completed in line with policy and procedures. We looked at a variety of health and safety records and the checks that staff do to prevent people from being placed at risk of harm. A monthly health and safety audit is undertaken in addition to a number of checks such as fire tests, emergency lighting etc. Equipment is serviced as required to ensure its safety and staff spoken with confirmed they receive training in safe working practices for example moving and handling, food hygiene, fire safety and infection control to ensure peoples safety. The manager confirmed that there are no outstanding requirements made by the Fire or Environmental Health Departments. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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. Care Homes for Adults (18-65 years) Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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