Care Home: Sunnyside House

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What the care home does well People living at Sunnyside are supported to be as independent as possible. People were planning their holidays and said they liked to play pool, go shopping, to garden centres and going to college. People`s diversity is embraced and celebrated, with people having access to activities which reflect their interests and lifestyles with support to follow their beliefs or spirituality. People said that they enjoy the meals provided. They were observed helping themselves to drinks and snacks throughout the visits. Staff have access to regular training giving them the opportunity to acquire the skills and knowledge needed to support people living at the home. Robust quality assurance systems are in place which involve feedback from people living in the home. What has improved since the last inspection? Four requirements were issued at the last inspection and these had all been met. Guidance was in place in care plans indicating the support needed by people to manage their behaviour. Restrictions were noted and some people had signed these. The rationale for restrictions was recorded. A manager had been appointed and registered with us. The fire risk assessment had been Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 reviewed. Excellent use was being made of photographs and pictures to illustrate documents and records making them more accessible to people. What the care home could do better: The Service User Guide and statement of terms and conditions must include reference to any additional payments people may be required to make. Records monitoring what people have eaten must be improved so that nutrition and diet can be monitored. House meeting minutes could be produced in a format using pictures or photographs. People should have access to these. Key inspection report CARE HOME ADULTS 18-65 Sunnyside House Main Road Birdwood Glos GL19 3EA Lead Inspector Ms Lynne Bennett Unannounced Inspection 15th June 2009 13:30 Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnyside House Address Main Road Birdwood Glos GL19 3EA 01452 750491 01452 750405 sunnyside@orchardendltd.co.uk www.orchardendltd.co.uk Orchard End Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss Andrea Louise Davies Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 10 5th July 2007 Date of last inspection Brief Description of the Service: Sunnyside provides accommodation and personal care to ten people who have learning disabilities and some who may also have additional challenging behaviours. The home is divided into two separate living areas; the main house that can accommodate six people and the bungalow which can accommodate four service users. All people have single rooms. There are spacious grounds around the home. The home is set back from a busy main road in a rural village with some local amenities nearby. People are supported to use public transport and the home’s own transport to access a variety of community facilities in Gloucester and the Forest of Dean. The home is part of the group of homes known as Orchard End Limited, which is a subsidiary of C.H.O.I.C.E Limited. Fee levels for the home range from £1,121 to £1,863. The Statement of Purpose and last inspection record are kept in the office. Each person living at the home has a personal copy of the Service User Guide. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place during June 2009 and included two visits to the home on 15th and 16th June by one inspector. The registered manager was present throughout. She completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We talked to 3 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also looked at a selection of other records including staff files, health and safety systems and quality assurance audits. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Four requirements were issued at the last inspection and these had all been met. Guidance was in place in care plans indicating the support needed by people to manage their behaviour. Restrictions were noted and some people had signed these. The rationale for restrictions was recorded. A manager had been appointed and registered with us. The fire risk assessment had been Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 6 reviewed. Excellent use was being made of photographs and pictures to illustrate documents and records making them more accessible to people. 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. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to robust information, in a variety of formats, enabling them to make a decision about whether they wish to live at the home. A comprehensive assessment of the person’s wishes and needs are taken into consideration before offering them a place. Other people living in the home are involved in this process. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed to reflect changes in the management of the home. The Service User Guide had been produced in a format using text, pictures and photographs and was also available in an audio format. Each person had a copy of a statement of terms and conditions which had also been produced in a format using text and pictures. During the visit additional payments were discussed and it became evident that some people were paying for meals out or take-away meals when they chose not to eat in the home. This must be noted in these documents. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 9 The home had admitted two people since the last inspection and another person was due to move into the home. There was a comprehensive assessment of needs completed by the referrals manager. An assessment of needs and current care plan had also been provided from the placing authority with additional information from former placements. Records of transition meetings evidenced the planning process for new people and how they were supported to make a decision about whether they wished to move into the home. This included a series of visits to the home which included overnight stays. Records were kept of these visits providing further assessment information. People living in the home were also part of this process as a result of feedback they had given as part of the quality assurance system that they would like to be more involved in the admission of new people to their home. They had been asked to provide information about who they would like to live with and after visits by new people they were asked for feedback about their impressions of people. Surveys and documents used in this process were produced in a format using text and pictures. The management team discussed how they ensure that the home was able to meet people’s religious needs and how they had considered the needs of older people moving into the home. People who had moved into the home said they were happy living there. Other people said they were looking forward to the new person moving into the home and had enjoyed meeting them during their visits. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect people’s assessed needs and there is evidence that people are being supported to make choices about their lifestyles. Risks are being managed safeguarding them from possible harm. EVIDENCE: The care for three people was case tracked including a person who had moved into the home since the last inspection. New plans being put in place at the last inspection had been fully implemented. The date on which people had been admitted to the home had been omitted. A person centred approach to care planning was in place with each person being involved in the development of care plans, risk management plans and support guidelines and health action plans. Some people had signed records. These documents were produced in formats using pictures to illustrate the text. Plans were holistic, produced from an assessment of people’s physical, intellectual, social and emotional needs. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 11 There was evidence of regular review, formally every six months and annually with placing authorities. Where changes were occurring, key workers were noting this in the space provided on care plans and making any necessary amendments. Care plans identified agreed actions and goals based on people’s wishes and aspirations, for instance supporting people in their chosen activities or to maintain contact with people important to them. Support guidelines made reference to where appropriate risk management plans were in place. Staff spoken with had a good understanding of the needs of the people they support. They were observed supporting people in line with the guidelines in their plans. Communication plans indicated the way in which people preferred to communicate and their levels of comprehension and whether they reinforced the spoken word with sign language. There was excellent use of pictures and photographs around the home to illustrate key documents such as activity schedules and prompt sheets to learn new skills. Best interests meetings were being held where appropriate and management confirmed that one person had been referred for an Independent Mental Capacity Advocate(IMCA). Where there were restrictions in place these were recorded and the rationale for these noted. Most were in place to safeguard people from harm or to promote their well being. Some people had signed these documents. A protocol for the use of a listening device could not be found although management said it was in place. This was re-produced during our visit. Other protocols for the use of sensors were seen to be in place. A missing person’s file was in place with a photograph of each person and a pen picture. This had not been completed for the most recent person admitted to the home. The registered manager was reminded that this would also need to be put in place for the person due to move in. Hazards faced by people were fully risk assessed with a summary of identified concerns and how these would be minimized by staff. Individual risk management plans and additional risk assessments had been developed from this. People were being supported to take risks in a managed way reducing known hazards but still enabling them to be independent. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. It is difficult to assess the diet of some people from their meal records and whether they are being supported to have a nutritional and healthy diet. EVIDENCE: People’s care plans included sections on ‘What is important to me’ and ‘What I enjoy’ and ‘What I really don’t like’. Activity schedules were being produced for people using pictures to illustrate the text. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 13 A person said they were supported to go to church on a regular basis and staff confirmed that a person wishing to move to the home had been shown a local mosque. They said that a prayer mat would be made available and that festivals would be celebrated. People were going to local colleges for day and evening courses. People had opportunities for paid employment around the home. One person said they received payment for washing the home’s transport. The AQAA stated that one person had been employed to take part in the recruitment and selection of staff. The quality development plan for the home had identified that management needed to explore work opportunities and to create more opportunities for all to be involved in activities inside and outside of the home. People said they enjoyed doing pottery and also had access to ‘Vital therapy’ and a literacy tutor. One person said they liked baking and others were observed doing laundry. Gardening was popular with people and one person showed us the plot they were looking after growing some vegetables. During our visits people took trips to beaches taking a picnic on one day and eating out on another. Other people were supported to go shopping, using the computer or watching a DVD and entertaining friends. Activities were recorded on daily sheets and for the month of June indicated that people had access to a wide range of activities reflecting their interests and lifestyles. One person loves planes and frequently visited a local airport. Staff were also booking tickets to a forthcoming air show. Another person enjoyed visiting a local garden centre and playing bingo or pool. People had access to two people carriers and also used public transport. People said that they were supported by staff to visit their relatives for day visits or overnight stays. People were also keeping in contact with their friends and relatives via telephone or email. Friends visited people during our visits to share an evening meal. People were also meeting up with friends at the pub or social clubs. People were being helped to develop skills of daily living and prompt sheets had been provided with step by step guidance. People were observed choosing how to spend their time and with whom. They were also observed being supported to make decisions about their lifestyle which included respecting decisions not to take part in activities or wishing to spend time alone. Records indicated that people had taken part in two house meetings this year. Minutes were kept in the office and did not appear to be accessible to people. The AQAA indicated that this was an area for future improvement. Menus had been developed with people. Each person had chosen a meal they wanted to be included on the menu. Alternatives to the main meal were provided and there appeared to be lots of flexibility about providing an alternative to the main meal. Freshly prepared meals were being made during Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 14 our visits which included vegetables and salad. Meal records were being kept on daily notes but these did not always provide a comprehensive account of people’s diets. Several people in the home had diabetes and others were being encouraged to eat healthily due to weight concerns. Care plans clearly indicated the level of support needed. Their meal records did not provide sufficient detail to monitor whether they were having a balanced diet. Entries included, ‘ate out’, ‘take-away’, ‘KFC’, ‘cottage pie’ and ‘roast’. It would not be possible to determine whether they were having any fresh vegetables, salad or fruit from these entries. Discussions with management confirmed that they were supporting people to maintain a healthy lifestyle wherever possible. Some snacks were accessible to people such as fresh fruit and yoghurts and people had additional drink making facilities in the conservatory. Other snacks were stored securely. The rationale for this was recorded. People living in the bungalow were using the kitchen to prepare the occasional meal or snacks. Staff confirmed that special diets were being catered for in respect of people’s religions and beliefs. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care which people receive is based on their individual needs that are reflected in their care plan. Medication processes are in place that should safeguard people from possible harm. People’s wishes in respect of ageing and death are being discussed and records reflect these. EVIDENCE: Each person had a list of likes and dislikes which they had drawn up with staff. Their personal care needs were also recorded in a care plan. One person’s plan indicated that they preferred to be supported by female staff. Other plans did not indicate whether people had any preferences. One person was being supported to manage their diabetes. Excellent guidelines had been produced using pictures and photographs to illustrate the text explaining this condition, their treatment and what they should expect. Some staff had received training in Diabetes and managers confirmed other training was planned. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 16 Each person had a health action plan and there was evidence that they were having annual health checks. The ‘end of life’ section in the health action plan had been completed with one person and there were plans to address this for another person at their next review with their care manager. Healthcare records confirmed that people were having access to health care professionals. A summary sheet indicated their last appointment for instance with their Dentist and when the next appointment was due. This enabled staff to monitor frequency of appointments. It was evident that where people had anxieties about appointments or treatments staff were working with them to overcome these and to remake appointments where necessary. People were having access to a Psychiatrist and one person said they felt very supported by the regular meetings they were having. People were also having regular support from the local Community Learning Disability Team. Action agreed forms left by the team were on people’s files and appeared to have been implemented by the staff. The home administers medication from a monitored dosage system. Staff were completing training in the safe handling of medication and there were regular audits in place to assess staff competency. Staff were observed administering medication and this was done satisfactorily. Medication administration records were completed correctly. Protocols were in place for the use of ‘as necessary’ medication. A homely remedies protocol was in place. Evidence that people had consented to have medication administered by staff was not in place. These were produced during our visit and signed by people. Where people refused to sign their Doctor was contacted to provide authorisation. The temperature of the medication cabinet was being monitored and recorded, with corrective action being taken when needed. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident in the knowledge that any concerns they may express will be listened to and acted upon. Systems are in place that should safeguard people from possible harm or abuse. EVIDENCE: The home had a complaints procedure which had been produced in a format using text and pictures. People said they would talk to staff or the manager if they had concerns. The AQAA confirmed this stating, ‘Sunnyside House have a clear procedure for complaints that service users have used to air their views about anything that they are not entirely satisfied with.’ The complaints folder contained copies of the 12 complaints received by the home since the last inspection with a record of action taken as a result of the complaint. These indicated that people living in the home felt confident in the use of the complaints procedure and that any concerns would be listened to and action taken. Staff had completed training in the safeguarding of adults and were due to have additional training provided by the organisation specific to people living in the home. Those spoken with had a good understanding of abuse and their responsibility in identifying and reporting concerns. The home had worked closely with the local Adult Protection team since the last inspection. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 18 New training was being cascaded around the organisation in the use of SCIP (Strategies for Crisis Intervention and Prevention) and risk management plans were being reviewed to reflect this. Those examined provided staff with clear guidance about how to recognise triggers and how to support people to manage their anxieties and anger. Staff confirmed that a consistent approach from the team was having positive benefits (very little use of physical intervention or ‘as necessary’ medication) alongside their greater understanding of how to support people. Concerns had been expressed to us about the occasional inappropriate behaviour towards people of the opposite sex. Risk management plans and support guidelines gave clear and specific guidance to staff about how to manage this and what action to take. Staff spoken with reflected this and said that if incidents occurred involving sexual assault they would follow the home’s procedure for reporting this to the police. The procedure was supplied to us after the visits to the home. We suggested that this was reviewed to reflect situations where police involvement may be needed urgently and how to support the victim. The procedure should also make reference to the home’s safeguarding procedures. People were supported to manage their personal finances. Robust procedures were in place for monitoring and checking. This was observed during our visits. Records for the people involved in the case tracking exercise were examined and found to be satisfactory. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the environment are creating a home which is homely, comfortable and pleasant to live in. People are being involved in this process helping to adapt the home to suit their personal requirements. EVIDENCE: The day to day maintenance arrangements for the home had recently changed, improving the way in which repairs were dealt with. During our visits the maintenance department were at the home dealing with a number of issues which had been highlighted by staff and people living in the home. The general décor of the home and bungalow were good, having been recently redecorated. The AQAA indicated that people had been involved in choice of colour schemes for their rooms and were purchasing new curtains and bedding. They had also been consulted about colour schemes in communal Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 20 areas and choice of furnishings. There were plans to buy new curtains for communal areas and replace carpets. Some fixtures and fittings had been replaced since our last visit. The grounds around the home were well maintained and the driveway had been resurfaced. The home had previously had a number of animals but these were no longer being kept. People spoken with said they were fine with this. At the time of our visit the home was clean and tidy. Staff said they have responsibility for the cleaning and involved people with this. People were observed using the laundry. Each person had their own basket for their laundry. Personal protective equipment was provided for people. One member of staff was observed wearing a plastic apron throughout the shift, this is not advisable and should be worn only in the area for which it is designated. For instance, blue aprons as protection in the kitchen and white aprons for personal care. The AQAA stated that the home ‘Uses Department of Health Essential Steps to assess current infection control management.’ Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a competent staff team who have access to a robust training programme to equip them with the knowledge and skills to meet their needs. People living in the home are involved in the recruitment and selection procedures which should safeguard them from possible harm. EVIDENCE: Since the last inspection the staff team has remained fairly consistent with a core of experienced staff being joined by new team members with no experience of care. Staff said they were developing as a team to provide continuity of care and a consistent approach to people living in the home. The DataSet indicated that 59 of staff had completed their National Vocational Qualifications (NVQ) in Health and Social Care and that an additional 22 were completing their awards. Staff had completed inductions which were equivalent to Skills for Care Foundation standards and had access to Learning Disability Qualifications. Those spoken with had a good understanding of the needs of the people they support. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 22 A sample of files for new staff appointed in 2008 and 2009 were examined. Some people had been appointed before their Criminal Records Bureau check had been received. There was evidence of two satisfactory references being in place along with a Pova first check and a risk assessment indicating what duties they could do. Each person had a full employment history and there was evidence that where there were gaps these were being explored with applicants. Proof of identity and photographs were in place or being obtained. Copies of birth certificates were destroyed during our visit in line with Data Protection recommendations. As mentioned people living in the home were being involved in the recruitment and selection process. The AQAA stated, ‘People that live at Sunnyside House are supported to be involved in the recruitment of their staff by attending interviews and being involved in the decision making process of offering candidates employment or not where appropriate.’ A training matrix was in place confirming that staff have access to mandatory training and refresher courses when needed. Training in courses specific to the needs of people living in the home has been provided such as Diabetes, Epilepsy, Autism and Mental Health. The latter course was being repeated for staff later in the year. Some staff had also completed Sexuality and Learning Disability and the needs of Older People. Staff confirmed that the training programme was excellent with some courses being provided specifically focussing on the needs of people living in the home. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a well run home. Effective quality assurance systems are in place involving people who live there. Satisfactory health and safety systems are in place providing a safe environment. EVIDENCE: The registered manager has considerable experience in care and supporting people with a learning disability. She has a NVQ in Health and Social Care at Level 4 and the Registered Managers Award. She has completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards. She has also completed a course in stress awareness. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 24 Good practice was observed to be in place in relation to the management of food hygiene. Items were labelled in the fridges with dates of opening and temperatures kept for fridges, freezers and hot food. The ‘Better food, safer business’ guide was being used to monitor practice in the kitchen. She supplied the AQAA to us by the deadline supplying us with satisfactory information about the home and future improvements. Staff were scheduled to complete training in the Mental Capacity Act and Deprivation of Liberty Safeguards. As mentioned there was evidence that IMCAs were being involved with people where appropriate and the necessary assessments and records were being completed by the home. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. CHOICE have a quality assurance system in place which includes monthly unannounced visits to the home with a production of a report and action plan.. In addition to this the Operations Manager had completed an annual audit of the service which included feedback from people living in the home, families and external agencies. The registered manager had a copy of the Improvement Plan for 2008 and was able to evidence that these improvements had taken place. This year’s process was scheduled to start in August. CHOICE had introduced a new Internal Inspection Procedure which was completed in May by an Operations Manager from another area inspecting to the National Minimum Standards. The outcome for this standard was excellent. Systems were in place to monitor health and safety around the home. A Regulation 26 visit had highlighted that fire systems were not being monitored at regular intervals and that action had been taken to address this. Records examined at the inspection were not clear about the frequency of tests but staff confirmed that they were now being completed at appropriate intervals. The home had received an inspection from the local Fire Service and they had identified breaches in their regulations. The home had complied with these. A fire risk assessment was in place and evacuation procedures promoted a full evacuation of the home. This was observed during a fire drill during our visit. The AQAA stated servicing of equipment and utilities were being completed. Records on site confirmed this. Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 4 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 4 12 3 13 4 14 4 15 4 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 4 X X 3 X Version 5.2 Page 26 Sunnyside House DS0000055006.V375941.R01.S.doc Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(c) Requirement Timescale for action 30/08/09 2. YA17 17(2) The registered person must make sure the service user guide and terms and conditions indicate the costs of the service to people. This is in respect of paying for meals outside of the home. This is to make sure people are aware of any additional costs they have to fund. The registered person must keep 30/07/09 a record of food eaten by people in sufficient detail that diets and nutrition can be monitored. This is to make sure that people are supported to maintain a nutritional and healthy diet and that appropriate action can be taken if concerns are raised. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 27 1. YA6 The date when people were admitted to the home should be recorded in care plans. Care plans should indicate people’s preferences about the gender of staff providing personal care. The missing person’s folder should be kept up to date. Consider producing house meetings in a format appropriate to people and making them accessible to people living in the home. A procedure on Police Intervention should be reviewed. Personal protective equipment such as aprons should not be worn around the home but in designated areas and then disposed of. 2. 3. 4. 5. YA9 YA16 YA23 YA30 Sunnyside House DS0000055006.V375941.R01.S.doc Version 5.2 Page 28 Care Quality Commission North Eastern Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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