Care Home: Sunnymead Manor

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well Sunnymead Manor is located within a pleasant residential area close to Bristol City Centre. The home has been redecorated to a required standard and furnishings are also of a good quality. At our visit the home was found to be clean and tidy and odour free. The home has a clear admissions process and individuals needs are assessed prior to admission into the home in order to ensure that individuals needs are able to be met. Care plans are well written and are updated when required and are kept under review. People who live at Sunnymead Manor are well supported by the home and other agencies in order to ensure that all aspects of their health care are met. The chef demonstrated a good understanding of the special dietary needs and specific food preferences of people living at the home and gave us a number of examples of individuals choices and special dietary needs and how these are catered for at the home. The home has clear policies and procedures in order to direct and guide staff practice. Staff have received training in all core competency areas, as well as specialist training. Staff also demonstrated a sound understanding of the needs of individuals living at the home and were able to provide good examples of how dignity and respect is promoted at the home. Staff appeared to be well motivated and committed to providing a good service to those who live at the home. The manager leads by good example, the manager has a sound understanding of the complexities of managing a large, diverse staff team and has demonstrated excellent communication and motivation skills. What has improved since the last inspection? There have been a number of significant improvements since our last visit to the home that had been undertaken in January 2009. 18 requirements and 4 recommendations were made. All of these had been met by the home. From the evidence we have seen, from the people we have spoken with and from the outcomes which have been achieved for people who live at the home it was evident that the home, its manager and staff team have worked diligently in order to improve standards to ensure that standards are maintained and that a good service is provided for those who live at the home. What the care home could do better: In order to ensure that peoples valuables are clearly accounted for, it is required that items of value that are held for safekeeping at the home, must be recorded on a property/valuables sheet. In order to ensure that respectful photographs of individuals are in place at the home, it is recommended that non flattering photographs of residents are replaced. Consideration should be given to the use of the term `wandering` within residents records in order to demonstrate staff understanding of the needs of those who have a dementia Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunnymead Manor 575-579 Southmead Road Southmead Bristol BS10 5NL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 0 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sunnymead Manor 575-579 Southmead Road Southmead Bristol BS10 5NL 01179791212 01179792680 Telephone number: Fax number: Email address: Provider web address: None Name of registered provider(s): Type of registration: Number of places registered: Mimosa Healthcare (No4) Limited care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: May accommodate 34 persons within the OP category in The Hollies Unit. May accommodate 42 persons with Dementia in The Poplars Unit. The maximum number of service users who can be accommodated is 76. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum number of places 34 Dementia (Code DE) maximum number of places 42 Date of last inspection 0 3 1 2 2 0 0 8 42 0 Over 65 0 34 Care Homes for Older People Page 4 of 31 Brief description of the care home Sunnymead Manor is a 76-bedded care home, situated in the Southmead area of Bristol, close to the South Gloucestershire borders. It is operated by Mimosa Healthcare Limited. Mimosa has three other care homes in the Bristol area Bedminster (Honeymead Care Home), Bishopsworth (Bishopsmead Manor) and Shirehampton (Kingsmead Lodge). Mimosa also own homes in the Midlands and the North of England. The home is located near to Southmead Hospital and only a short distance from the centre of Bristol. There is a regular bus service into the centre of town that passes the front of the home. Sunnymead is a purpose built care home with accommodation provided over two floors. The home is run as two units. The first floor, Poplars unit, accommodates 42 persons requiring specialist dementia care nursing. The ground floor, the Hollies unit, offers 34 beds for general nursing placements. Both floors have communal and bathing facilities, and there is lift access, making the home fully accessible. The majority of the bedrooms are for single occupancy and have en-suite toilet facilities. The cost of placement is between 498- 560 pounds per week, dependent upon assessed need. Additional charges are made for a number of services - these are listed in the homes brochure. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. Care Homes for Older People Page 5 of 31 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection which focused on the specific standards as laid down by the Commission for Social Care Inspection, now The Care Quality Commission, under its inspecting for better lives program. Areas we have covered have included admission processes, health and personal care, complaints and protection, fire safety, staffing, recruitment, training and the management of the service. This was our third inspection visit to Sunnymead Manor within the past twelve months. A random visit was completed in November 2008. The purpose of this random visit was to review some issues of concern that had been raised to us by a health professional who had been assessing the health care needs of an individual at the home. Some of the issues raised to us were upheld and requirements in respect of these were made. A Care Homes for Older People Page 6 of 31 key inspection was completed at the home in January 2009 and at that time we rated the service as one which provided poor outcomes for people who used the service. Following this inspection a number of meetings have been held with us, representatives of the service and contracting local authorities. At these meetings the home provided evidence of improvement and demonstrated a commitment to compliance and improving standards at the home. This visit to the home was conducted over three days, we spent time in both The Hollies and the Poplars unit, we visited during the morning and afternoon, we also returned to the home on the evening in order to observe a relatives meeting that had been arranged by the home to inform people of progress made at the home. A total of twenty three hours were spent at the home. During this visit we examined the care and associated records for eight of the people who live at the home. We also looked at records relating to fire safety, staff employment and training records. Time was spent talking with people who live at the home. Time was spent with people in individuals private rooms and also in the main communal areas. We spoke with qualified staff, care assistants, the chef, domestic and laundry staff. Time was also spent with the manager and the area manager for the company. What the care home does well: What has improved since the last inspection? What they could do better: In order to ensure that peoples valuables are clearly accounted for, it is required that items of value that are held for safekeeping at the home, must be recorded on a property/valuables sheet. In order to ensure that respectful photographs of individuals are in place at the home, it is recommended that non flattering photographs of residents are replaced. Consideration should be given to the use of the term wandering within residents Care Homes for Older People Page 8 of 31 records in order to demonstrate staff understanding of the needs of those who have a dementia 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 set out 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 Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. There is comprehensive information describing the service available to individuals living at Sunnymead Manor. Individuals needs are assessed prior to admission and these are kept under review. Evidence: Sunnymead Manor is a care home registered with The Care Quality Commission (CQC) to provide personal care and accommodation for up to 76 older people, some of whom may have a diagnosis of dementia, others who may require nursing care support. At this visit we reviewed the homes statement of purpose. We saw that this document had been well written and contained clear information about the main aims and objectives of the home and the facilities and services provided by the home. Within the statement of purpose we found detailed information about the organisational structure of the home, including names and contact details of key individuals. Information was included about the pre admission assessment and process for Care Homes for Older People Page 11 of 31 Evidence: entering the home. Important information for residents and prospective residents was also provided within this document such as emergency and fire procedures and how the home responds to and deals with complaints. The home also provides people with a summary of the last inspection report undertaken by us. The home also has an informative welcome pack, this provides useful information about the services and faciltities available to those who live at the home, this document is well written and was found to be up to date with appropariate information as required. At our last visit to the service a requirement was made that the Registered Person must ensure that the home is able to meet the assessed needs of those living at the home, a review of documentation at this visit found this requirement to have been met. At this visit we found that the home has a clear assessment for when people have been admitted to hospital for treatment. This assessment is completed by either the manager or a senior qualified member of staff prior to them returning to the home. The home also ensures that the individuals allocated key worker visits them in hospital and their role is to also liase with the professionals at the hospital in order that an assessment of their needs is completed, this ensures that peoples needs are able to be met at the home prior to their return from hospital. We spoke with a relative who told us about the initial assessments process for their relative prior to being admitted to the home. They told us that the manager was wonderful, so thorough and attentive to the needs of my relative. They informed us that they had visited a number of care homes before deciding on Sunnymead. They also said that the manager had ensured that the information gathered through the assessment process has been cascaded to all members of the staff team and informed us that the assessed needs of their relative are being well met at the home. They also told us that their relatives health and wellbeing had improved since their admission into the home, that their relative was more alert and communicative. We were informed by the home that all people who live at Sunnymead are issued with a contract which outlines the terms and conditions of the placement, we sampled records and saw that these were in place and contained required information in respect of what is expected from them and what they can expect from the service. We were also informed that the home has produced a copy of the terms and conditions of the placement in vocal tape for an individual who is registered blind, this person confirmed to us that this had been provided and they found this to be of great use and provided clear and accurate information to them. Care Homes for Older People Page 12 of 31 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Individuals personal and health care needs are being well met. Care plans were in place and significant information had been recorded on the care plans for the individuals who live at the home, these are kept under review and updated as required. The Manager and staff were able to demonstrate a good understanding of the needs of individuals who live at the home. Individuals are protected by the homes medication administration and recording. Evidence: At our last visit to the service we were not satisfied with the level of information and detail recorded within individuals care plans, a requirement was made that the care plans within the Poplars unit must be meaningfully reviewed and revised in order that they remain effective. We reviewed six care plans in this unit and found that all of the plans had been re written and all had been monitored and kept under review since our last visit. The home is working hard to develop care plans which are more person centered and the manager is committed to ensuring that these are in place for all residents at the home. We further noted that care plans for those people who have Care Homes for Older People Page 13 of 31 Evidence: complex mental health had clear information about individuals triggers and how they should be supported in order that they do not become distressed or anxious. We reviewed the daily records written about individuals who live in the home. These record the support that individuals have had, what activities they have been involved with, healthcare support and individuals general wellbeing as well as relationships. These were well written. We did note that there were occasions when staff had used the term wandering to describe people who walk around the home. It is recommended that consideration should be given to the term wandering used within records in order that this does not create a negative image of individuals. It was evident at this visit that the staff are sensitive to the emotional, physical and health needs of those living at the home and through observation and discussion demonstrated respect to the wishes of individuals living at the home. Furthermore staff were observed going about their duties in a friendly and calm manner and responding to the people living in the home in a friendly, familiar style. During our last visit to the home three requirements in respect of medication administration and practices were made, at this visit we found these requirements to have been met. The pharmacist inspector looked at how medicines are looked after in the home. Nurses told us that at present they look after and give all the medicines in the home except for one person who looks after their own eye drops. People living in the home are registered with one of several local doctors practices. Records showed that doctors visit the home to see their patients. The manager told us that since the last inspection all the people living on the first floor have had their medicines reviewed with their doctor. This helps to protect peoples health by ensuring that they are prescribed appropriate medicines. Medicines are supplied by a local pharmacy using a monthly blister pack system. The pharmacy provides printed medicines administration record sheets each month for staff to complete when they have given medicines. We arrived at the home at 9:30 in the morning and the nursing staff were just finishing giving the morning medicines. The nurses told us that they have two nurses on each floor in the morning, which means that one nurse can give the medicines without being interrupted. This helps to ensure that medicines are given safely at a suitable time. Staff sign the medicines administration record sheet when they give the medicines. We checked a sample of blister packs and a sample of medicines supplied in standard Care Homes for Older People Page 14 of 31 Evidence: packs with the administration records.These indicated that the medicines had been given as prescribed by the doctor. When medicines had not been given staff had recorded the reason. Some medicines are prescribed by the doctor to be given when required. We saw record sheets detailing the correct dose of medicine to be given, the maximum daily dose and the reason for giving the medicine. This means that nurses have information available to make sure that they give these medicines appropriately. however we noticed that a sheet for one persons medicine had some incorrect information and needed changing. Staff must ensure that information sheets are accurate and up to date so that medicines are given safely. We saw records of the receipt of medicines into the home and the disposal of unused medicines. This means that there is an audit trail to show that medicines have been used safely. Safe storage is available on each floor of the home, together with a medicines fridge and special storage for medicines which need additional security. This means that medicines are looked after safely in the home. There are good arrangements for access to health services including dental, optician and chiropody. We saw that the home maintains primary care records and this showed us that people access a wide range of health and emotional care support service. The community district nursing service also provides a service to the home to support those individuals who require regular support with wound dressings. Records were kept of the appointments that people had with their GPs and other healthcare professionals. Records had been completed after each appointment, which provided a good report of the outcome and any action that needed to be taken as a result. The manager also told us about a partnership development programme that has been introduced at the home. This includes representatives from relatives and individuals who live at the home, health professionals and staff at the home. The purpose of this initiative is to improve and develop the services provided by the home in order to fully ensure a good quality of life for people living at Sunnymead. This initiative demonstrates a sound commitment from the home to liase with others in order that the best interests of people living at the home are met. We look forward to reviewing progress in this area when we next visit the home. We spoke to a visiting professional who was at the home at the time of our visit. This person or a representative of their team has visited people who live at the home for a long period of time. A new system has been introduced whereby people are visited by Care Homes for Older People Page 15 of 31 Evidence: these professionals on a weekly basis. This person told us that they had noted improvements at the home over the past few months, in particular that people living at the home do not look unkempt and that the environment had improved with decor and new furnishings. Within peoples records we noted that in all of the files we reviewed, the people living in the home had a photograph in place. These photographs are required for individual identification purposes. Of all of the photographs we saw two of them were less than flattering for people and it is recommended that these photographs be retaken. During our last visit to Sunnymead we reported our concerns and observations in respect that people were not being treated with dignity and respect. At that visit people looked unkempt, this was not the case at this visit. People looked well cared for and were neat in appearance. We saw within staff induction files that they had been questioned about their understanding of how to treat people living at the home with dignity and respect. The questionnaires were well written and asked staff how they can help preserve peoples dignity and why respect is important. In the questionnaire we saw, completed, the staff member demonstrated a sound understanding in this area. Since our last visit the home has developed and are promoting a dignity in care programme. Staff and people who live at the home are trained and supported to ensure that they have an understanding in this area. It is when individuals are trained that they are available to provide support to the people who live at the home, to champion their rights and ensure that all are treated with dignity and respect. A member of staff we spoke with told us about treating people with dignity and respect and about valuing people as adults. This member of staff has a sound understanding of the diverse needs and wishes of people living at Sunnymead Manor and spoke of people as individuals. This same staff member, and the manager gave a number of examples to us to demonstrate that if people living at Sunnymead Manor become anxious or distressed due to their mental health state they are given reassurance, guidance and comfort. They described how this impacted on peoples quality of life at Sunnymead Manor. Care Homes for Older People Page 16 of 31 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Those living at the home are enabled to maintain contact with families, friends and local communities. Choices are provided in respect of meals and mealtimes. The home provides those living at Sunnymead Manor with structured and meaningful activities and they are able to choose whether they wish to participate or not. Evidence: During this visit we saw that staff were friendly, polite and caring in their approach. They were seen to be supportive. We saw them listening to people and answering questions, providing reassurance and information as requested. We saw within the homes statement of purpose that visitors are welcome to the home. There are some people who have regular visitors others do not. During our visit we spoke to seven relatives of individuals who live at the home, they were visiting at the time of our visit. People sought us out during our visit in order to speak with us and tell us about the care of their relatives. One person told us My husband has been in the home for many years, he is well cared for another person who visits their relative on a daily basis told us that they had no complaints, I have every confidence in the manager, the home is much cleaner now and I am extremely happy with the Care Homes for Older People Page 17 of 31 Evidence: support and care my relative receives. During our visit we spoke with a person who has been employed to undertake activities with those who live at the home, this person had been employed at the home since January 2009. This person told us of the varied activities that people are supported to participate in, this is done on an individualised basis and is dependent on individuals choice, ability and personal preferences. A number of people who live at the home have a dementia and some have limited verbal communication. Staff told us told us how they support people to engage and communicate in order to fully support people in line with their wishes. The activities co ordinator told us of the plans to develop memory boxes with people who live at the home. These would be tailored to the individual based on their preference, choices and special memories. Boxes will include a description of individuals family and objects familiar to the person will also be included. We look forward to reviewing these at the next visit to the service and seeing how these have an impact for those who live at the home. Within individuals activity records we saw that people have been supported to celebrate birthdays and special events. We also saw that a group of young people, known as the good news team visit the home and entertain the residents by singing. The manager and staff told us that this entertainment was well received and those living at the home appeared to enjoy this. One of the residents told us that they had recently enjoyed a pub lunch locally and also that they enjoyed the games provided at the home, such as bingo, indoor skittles and quizzes. During our inspection of the service we attended a meeting for relatives and friends of those who live at the home. This meeting had already been arranged by the home and we thought it would provide a good opportunity to meet with people and find out from them what they thought of the service being provided. At this meeting there was a person who lives at the home who was representing, and who would feedback to other people who are living at the home. During the meeting agenda items included an update on developments within the home, these included staffing recruitment and numbers, menus, refurbishment progress and information about the residents committee. During this meeting people were reminded about the complaints process and were also invited to make suggestions about how the service could be improved. The meeting provided a forum for people to be kept informed about issues related to the home and to discuss any issues, concerns and ideas people may have. At the Care Homes for Older People Page 18 of 31 Evidence: meeting all were encouraged to air their views. The home also produced a monthly newsletter, this is for those who live and work at the home as well as to provide regular updates and information to relatives and carers of those who live at the home. Relatives told us that this form of communication was useful to them in order to keep in touch with what is happening at the home. A copy of the newsletter is given to each resident upon publication. The lunch was seen and looked appealing and individuals all spoke positively of the food provided in the home: its always good much improved. On the days of this visit the meal was well presented and staff were available to assist individuals. Prior to our visit the home informed us that they had been awarded five stars from Bristol City Councils environmental health service following a recent inspection of the kitchen. This was confirmed to us by the chef and the home are to be commended for this. During this visit we were also informed by the provider and the chef that since our last visit the home has introduced a protected mealtimes system, whereby time for meals has been extended and staff are allocated to support people solely with mealtime support. At our last visit to the home we were concerned that people were not being offered alternative choices at mealtimes and a requirement was made for compliance in this area. This visit found this requirement to have been met, menus were reviewed, we spoke with people who live at the home, visitors and the chef who all confirmed the improvements in mealtimes choices, these are tailored to individuals dietary needs and preferences. We saw that the home has extensively liaised with individuals and their families in order to gain further insight and understanding about people, their life, hobbies, interests and favorite pastimes, all of which has been well recorded in line with good practice Care Homes for Older People Page 19 of 31 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. There is information to people on how to make a complaint about the service. There are clear systems and protocols in place to protect those who live at the home from abuse. Staff have been trained within the area of adult protection and those staff members we spoke with were able to demonstrate a sound understanding of their knowledge and responsibility in this area. Evidence: The home has in place a clear complaints procedure, this records how issues raised will be responded to and dealt with. We viewed the complaints record at the home and saw that since our last visit to the service issues that have been raised to the manager have been responded to in a timely, professional manner. Information had been well recorded and issues raised to the home had been throughly investigated by the manager with clear written evidence to underpin this. At the time of our visit we were aware that an issue concerning the protection of a vulnerable person who had lived at the home and had been raised to the local authority. The concern had also been raised to us. We spoke to the manager about this and also reviewed the information they had provided to a safeguarding strategy meeting about this. We are satisfied that the home had acted responsibly and had supported the individual. The concerns raised were not upheld by the local authority. Records of recently employed staff members were viewed and contained personal Care Homes for Older People Page 20 of 31 Evidence: information and record of identity. Other information seen included a record of previous employment, references, protection of vulnerable adults checks and satisfactory Criminal Record Bureau disclosures. We saw that staff had attended training about how to protect vulnerable people and this is also covered within the National Vocational Qualification undertaken by staff at the home. During our visit we asked three members of staff about the training they had received in order to check their understanding in this area. All of the staff we spoke with were able to demonstrate a clear understanding of the policy in place and the procedures to follow should they be concerned about the welfare of an individual living at the home. We saw in recordsthat staff have completed training in the protection of vulnerable adults. We also saw that this is an ongoing area of training and future courses have been arranged for staff. We spoke to many visitors during our time at the home. People we spoke with were brothers, sisters, husbands and wives of people who lived at the home as well as friends and other family members. As there are a number of people who live at the home who are not able to verbally tell us what the experience of living in the home is for them the views of others is valuable. We spoke with people who visit the home on a daily basis and others who do not visit as often. People were very positive about the care of their relative and told us how things had improved at the home. People told us that staff are more responsive to the needs of their relative, that the manager is always available and listens to any issues and responds in a prompt manner. Care Homes for Older People Page 21 of 31 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, 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. 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 at Sunnymead Manor live in a clean, homely, safe environment. Evidence: Sunnymead Manor is located within the residential area of Southmead, Bristol. It has local facilities nearby which include shops, banks, churches, pubs and restaurants. There have been a number of significant improvements in this area since our last visit to the home. At our last visit a number of requirements were made about improvements which were needed at the home, all of these have been dealt with. Appropriate action has been taken by the home and the requirements have been met. Improvements at the home have included the refurbishment of the Poplars unit including new furniture, redecoration and new flooring being provided. These areas were seen to be well furnished with furniture of a high standard and were well decorated. Lounges within all areas of the home were seen to be welcoming and homely with soft furnishings such as pictures, plants and ornaments. Since our last visit we found that the home has changed the layout of seating in the lounge area in order to make it more inviting. New lounge chairs have been ordered and were due to be delivered by the end of the week. Discussions are also taking place with people who live at the home in order that their preferences for new bedding Care Homes for Older People Page 22 of 31 Evidence: are recorded. Bedding is being replaced for all rooms within the home over a phased period of six months. Also the home now has a designated room in which activities are taking place and is also a quiet area for residents, we were told of plans to develop this area into a sensory room for residents in order that they have an area for relaxation. We look forward to reviewing progress in this area when we next visit the home. One person whose relative told us that prior to their admission into the home consultation took place about the decor in the proposed bedroom, it transpired that the persons favorite colour was green and that this was the colour of many of their rooms in their own home, prior to admission into Sunnymead. We were invited into this persons room and saw that it had been decorated green prior to the persons admission into the home, the relative felt that this had, had a calming reassuring effect on the individual. They were very pleased that the home had redecorated the room and had made it comfortable for their relative. The home has sufficient toileting and bathing/showering areas for individuals use. These areas are close to peoples rooms. During our last visit to the home a requirement was made that an identified bathroom must be cleaned in order that good standards of hygiene are maintained at the home, this area was checked by us at this visit and was found to be clean and tidy, light fittings which were faulty/missing in this area had also been replaced. The temperature in the home at the time of our visit was warm and comfortable. The home is appropriately adapted to meet the needs of the current group of people who live in the home. Specialist equipment has been obtained for individuals following identified need; examples of these include mobility, sensory aids, continence aids and equipment to assist with manual handling. We also saw a passenger lift is in place to support those with limited mobility. At our last visit a requirement was made that handrails should be provided in bathroom areas in order to support people with mobility difficulties, these had been fitted and were in place in all bathroom areas. We saw evidence that the home is well maintained; see the management section of this report for further information in respect of this. At this visit all areas seen were clean, tidy and odour free. Care Homes for Older People Page 23 of 31 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. The home ensures that all staff have been employed following robust recruitment and selection processes. Staff are trained to support older people, and core skills have been undertaken by staff. Evidence: The manager was able to demonstrate that she and the staff team have developed good relationships with those who live at the home and have a sound understanding of their needs, wishes and aspirations. These are well recorded in individuals records. We viewed rotas for the forthcoming week and saw that staffing provision appeared to be consistent with levels and skills needed due to assessed care needs of the individuals. The staff team have a varied range of knowledge and skills, they were observed by us to be good listeners, effective communicators and were interested and motivated in meeting the needs of those living at the home. On duty on the days of the visit was the Manager, for each floor there were two qualified nursing staff and five care staff, a chef and domestic staff were also on duty. The manager confirmed that at night there are sufficient number of staff on duty, who are awake, to support people during the night. Care Homes for Older People Page 24 of 31 Evidence: Information contained within individual staff files was all of a consistent standard. The files for three staff were reviewed; including a recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Records Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. We spoke to a member of staff who had been recently employed at the home as a care assistant. They showed their induction portfolio and spoke to us about the process and the standards that they have covered. We saw that these were in line with the guidance issued by Skills for Care and covered areas that included understanding the principles of care, the organisation and the role of the worker. Another member of staff told us about their role in supporting people at the home with activities, this person spoke with knowledge and warmth and appeared to have a good understanding of the individual needs of people who live at the home and what areas of interest and how support in these areas is provided. Staff files reviewed informed us that since our last visit staff have undertaken training in areas such as first aid, dementia awareness, mental capacity act, health and safety and manual handling, catheter and continence care along with infection control. The manager and staff confirmed to us that future training is planned and has been arranged in supporting individuals whose behavior may challenge and a dementia awareness distance learning pack, provided by Radstock College. Many staff have also completed a National Vocational Qualification in care, level 2 and domestic skills, level 1. Staff at the home have also been supported by health professionals with developing skills, the community mental health team have provided training in respect of depression in later life, end of life care and physical changes in older age. The primary healthcare trust have also provided clinical training in tissue viability care and diabetes. During this visit we saw that staff were respectful to those who live at the home and their privacy was respected. Staff spoke to people living in the home discreetly and politely, doors were knocked before entering and staff were heard asking permission and did not presume that it was okay to enter. Since our last visit the home has also introduced signs for doors which asks that the occupants are not disturbed as personal care is being provided. This was seen to be being used effectively during our visit, allowing for a better degree of privacy. Care Homes for Older People Page 25 of 31 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 home has systems in place to ensure the safety of those who live and work at the home. Risks are well recorded and there is evidence to demonstrate that staff have received a sufficient amount of fire instruction. There is also information in place to demonstrate that incidents, which affect the wellbeing of people who live at the home, have been managed, responded to and recorded effectively. Evidence: There is no registered manager in post at this service. The manager in post at this current time is suitably qualified and has the necessary skills and experience in order to fulfill the duties which are required of this post. The manager has submitted an application to The Commission and is awaiting confirmation from us of a date for their interview in order that their fitness to manage the service can be assessed. At this visit the Manager spoke with us about the importance of an inclusive culture Care Homes for Older People Page 26 of 31 Evidence: within the home, where staff take ownership of what they do and have clear lines of responsibility and accountability. The Manager was able to provide some clear examples of how this has been developed within the home. Staffing structures and new working patterns within the home have been implemented and these seem to be working well. Staff are being supervised and monitored in respect of their performance issues and appropriate action is taken when required. The Manager fully engaged with us during this visit and was able to locate most of the necessary information and documents easily. This shows that generally the home has good systems in place and is well run. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and staff had received the required sessions. Areas of discussion included guidelines and policies of the home, individuals expectations and an evaluation of their performance and how this can be developed. We saw minutes of staff meetings and saw that these take place on a consistently regular basis, with appropriate areas of discussion taking place. Performance issues, effective communication and consistency and quality of service are discussed, action plans agreed. We saw that the home has in place a detailed fire risk assessment, this assessment had been recently reviewed and covered what the procedure is at night and outlines individuals responsibility in the event of a fire emergency. The home also had in place a comprehensive fire risk assessment, that identified potential hazards, assessed those who were at risk, methods of control and also recorded where further controls that are necessary. We viewed the fire logbook for the home. The home was completing the appropriate checks on the fire equipment and the recording of fire drills and the testing of equipment were satisfactory. We saw the fire panel in working order. We spoke to the person at the home responsible for maintenance repairs and saw records which evidenced that faults are dealt with promptly and efficiently. We also saw records to confirm that equipment is checked by contractors, at the required intervals in order that they are safe for use. Staff members receive training in manual handling. We also saw information which staff are given to ensure they use only correct manual handling practices. We saw that each person living at the home had a manual handling assessment in place. Each assessment included information in order to guide and direct staff practice in order that those living at the home are moved in a safe manner. Care Homes for Older People Page 27 of 31 Evidence: At our last visit to the home a requirement was made by us that the registered person must ensure that receipts are provided for chiropody and hairdressing services that are provided to people who live at the home, at this visit we saw that this is in place, clear records are kept and this requirement has been met. We found at this visit that for one person the home held valuables for safekeeping, no record was maintained for this. A requirement was made that a record must be maintained of valuables which are held at the home for safekeeping. This is in order to ensure that a clear audit trail of individuals property is maintained. During our last visit we reported our concerns over the unsafe use of wheelchairs. The home was using wheelchairs that were dirty and unsafe for use. At this visit, over each of the three days we observed no concerns, we checked wheelchairs and saw that they were all in good working order, and were clean. These requirements had been met. During our last visit we found that a bathroom had cleaning products which had not been stored safely. A requirement was made that chemicals which may be dangerous to residents must be stored safely. We saw that cupboards containing chemicals were locked and no concerns were noted by us at this visit. Care Homes for Older People Page 28 of 31 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 Older People Page 29 of 31 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 1 37 13 A record must be maintained 03/08/2009 of valuables which are held at the home for safekeeping. This is in order to ensure that a clear audit trail of individuals property is maintained. 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 1 7 Consideration should be given to the replacement of the non flattering photographs in place for those people who live at the home. Consideration should be given to the term wandering used within individuals records in order that this does not create a negative image of individuals. 2 7 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!