Care Home: Sunnyside Nursing Home

What the care home does well People can be confident that staff are alert to changes in their health and seek guidance and advice from healthcare professionals in a timely way. Good records are kept of these discussions so that it is clear what extra help is needed. This helps to maintain people`s wellbeing. People responding in their surveys think highly of the staff. Two relatives commented `since my relative came here they regard Sunnyside as their home and is so well treated and cared for by all the staff`. And `staff make a big difference to a place and I can`t fault any of them`. The way medicines are managed at the home is good. Regular checks are carried out to make sure the drugs are being given and signed for properly. This also helps to maintain people`s health as much as possible. People are recruited properly and checks carried out, to make sure that only suitable people work at the home. Good recruitment processes contribute to keeping people safe. Visitors are welcomed at any time, which helps people to stay in touch with the people that matter to them. People receive a varied and nutritious diet, including home baking and fresh fruit, and catering staff know people`s needs well and how to provide them with special diets if necessary. This helps to promote people`s wellbeing. What has improved since the last inspection? An activities person is now employed at the home for seventeen hours a week to make people`s lives more varied and interesting. She has done some training to help her identify activities that people with dementia may benefit from. Some people who have no family now have independent advocates. Advocates are used to make sure that an individual`s best interests are always considered when decisions about them are being made.Sunnyside Nursing HomeDS0000045066.V375440.R01.S.docVersion 5.2Changes in the way the home operates means that people now have more choice where to sit and there is now a `circuit` where people can walk around and get back to where they started from. This provides them with a purpose and reduces the frustrations of not being able to go where they choose. There has been some redecoration and refurbishment at the home. This improves the environment for the people living there. There is now a quiet lounge, away from the television, so people have more choice as to where they spend their time. Staff have been supported to attend compulsory refresher training updates so that they have more up to date knowledge to help them work safely and effectively. The home is now trying to include people and their families more when deciding on proposed changes and future plans for the home. This gives people an opportunity to influence how the home runs. What the care home could do better: The pre-admission assessment could be always carried out by a trained nurse. This could help to make sure that all an individual`s needs are looked into properly before a decision is made about whether an individual should move to the home. And all professionals who are involved in the individual`s care could be consulted before an admission goes ahead, to make sure the placement would be appropriate. The records describing the care and support people need could be more person-centred, stressing their abilities and strengths, and how staff can support them in maintaining some choice and control of their daily lives. This would help to respect people as individuals with very different needs. Where an assessment of risk of harm is identified, for example the risk from choking, or risk from the environment, then there needs to be a plan in place describing how that risk is to be minimised. This will help to promote a consistent approach from all staff. The way people are supported could be looked at to ensure their privacy and dignity is respected at all times. This includes making sure they are seen by a doctor in private and making sure ladies are properly dressed. All staff could talk to people in a more positive manner and interact in a way that might mean something to the individual. They could explain what they are going to do, before they do it, and they could wait for people to respond to their questions, wherever possible. They could tell people what their meal is before starting to assist them with eating it. This would mean people are being shown more respect.Sunnyside Nursing HomeDS0000045066.V375440.R01.S.doc Version 5.2 All staff could know what they must do if they suspect, witness or are told about an incident which may be abusive. They could know that they could inform the local authority directly if they felt unable to approach someone from the company. This increased knowledge could help to keep people safe. Some identified shortfalls, which are needed to protect the health and welfare of people who live and work there could be addressed, so that people can be kept safe. The company could continue to redecorate the home and the corridors to make it more stimulating for the people who live there. And the policy of keeping bedroom doors locked during the day could be looked at according to individual needs and also explained to people and their families in advance of them moving there. This would help to make them aware that the home generally works in this way. Key inspection report CARE HOMES FOR OLDER PEOPLE Sunnyside Nursing Home 6-8 Oxford Road Dewsbury West Yorkshire WF13 4LN Lead Inspector Jean Dobbin Key Unannounced Inspection 09:30 3rd and 9th June 2009 03/06/09 DS0000045066.V375440.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Sunnyside Nursing Home DS0000045066.V375440.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 Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnyside Nursing Home Address 6-8 Oxford Road Dewsbury West Yorkshire WF13 4LN 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) 01924 462951 01924 457870 hayleyglover@tiscali.co.uk Northfields Care Homes Ltd Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Can accommodate two named service users under 65 years of age category DE. Can accommodate one named service user aged under 65 years of age category - DE MD PD. Can accommodate two service users under the age of 65 years but no younger than 55 years of age within the category MD DE. 27th August 2008 Date of last inspection Brief Description of the Service: Sunnyside is situated on the outskirts of Dewsbury and is a large detached building of two Victorian semi detached houses and a modern extension, with single and shared rooms, on two floors. There is also a basement where the laundry and other ‘service rooms’ are situated. The home provides nursing care and accommodation for up to 30 people with dementia related care needs. There are four lounges, a dining room and a sun lounge, and a vertical passenger lift to the first floor. There are attractive, mature gardens at the front of the house, though these are not currently available for people to walk out in. Car parking facilities at the rear are limited, though there is on-street parking close by. Access to the entrance, which is at the back of the building, is difficult because the approach is via an un-adopted road, which is in a poor state. There is a pedestrian ramp to the main entrance. The Statement of Purpose and latest inspection reports by the Commission for Social Care Inspection as the predecessor to the Care Quality Commission are displayed in the entrance area and are available for people to look at. The weekly fees provided on 9th June 2009 are from £394 to £434 per week. This does not include the extra free funding to meet nursing care if people have been assessed as being entitled to this. Additional charges are made for transport, such as to the hospital or dentist, hairdressing, chiropody and personal toiletries. Sunnyside Nursing Home DS0000045066.V375440.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 1 star. This means the people who use this service experience adequate quality outcomes The last inspection of Sunnyside Nursing Home was on 27 August 2008. This is what was used to write this report. • • Information about the home kept by the Care Quality Commission. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information obtained in a random inspection carried out on 6 January 2009 when checks that requirements made following the last inspection had been met. Reference to this inspection is made in the body of the report. Information from surveys, which were sent to some people who live at Sunnyside, to staff and to other professional people who visit the home. 10 were sent to people at the home, and 7 were returned. 6 were sent to healthcare and social care professionals and 1 was completed and returned. 5 were sent to staff at the home and 4 were returned A visit to the home by one inspector, which lasted in total about 9.5 hours. The visit took place over 2 days. This was because unforeseen events at the home caused the inspection to be cut short on the first day. A return visit a few days later enabled the inspection to be completed. This visit included talking where possible to people who live there and to a visiting health care professional. Also to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Time was also spent watching the general activity and how staff responded to people, to get an idea about what it is like to live at Sunnyside. • • • • • Information about what was found during the inspection was given to the temporary manager and a senior manager from the company, at the end of the visit. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 6 We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People can be confident that staff are alert to changes in their health and seek guidance and advice from healthcare professionals in a timely way. Good records are kept of these discussions so that it is clear what extra help is needed. This helps to maintain people’s wellbeing. People responding in their surveys think highly of the staff. Two relatives commented ‘since my relative came here they regard Sunnyside as their home and is so well treated and cared for by all the staff’. And ‘staff make a big difference to a place and I can’t fault any of them’. The way medicines are managed at the home is good. Regular checks are carried out to make sure the drugs are being given and signed for properly. This also helps to maintain people’s health as much as possible. People are recruited properly and checks carried out, to make sure that only suitable people work at the home. Good recruitment processes contribute to keeping people safe. Visitors are welcomed at any time, which helps people to stay in touch with the people that matter to them. People receive a varied and nutritious diet, including home baking and fresh fruit, and catering staff know people’s needs well and how to provide them with special diets if necessary. This helps to promote people’s wellbeing. What has improved since the last inspection? An activities person is now employed at the home for seventeen hours a week to make people’s lives more varied and interesting. She has done some training to help her identify activities that people with dementia may benefit from. Some people who have no family now have independent advocates. Advocates are used to make sure that an individual’s best interests are always considered when decisions about them are being made. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 7 Changes in the way the home operates means that people now have more choice where to sit and there is now a ‘circuit’ where people can walk around and get back to where they started from. This provides them with a purpose and reduces the frustrations of not being able to go where they choose. There has been some redecoration and refurbishment at the home. This improves the environment for the people living there. There is now a quiet lounge, away from the television, so people have more choice as to where they spend their time. Staff have been supported to attend compulsory refresher training updates so that they have more up to date knowledge to help them work safely and effectively. The home is now trying to include people and their families more when deciding on proposed changes and future plans for the home. This gives people an opportunity to influence how the home runs. What they could do better: The pre-admission assessment could be always carried out by a trained nurse. This could help to make sure that all an individual’s needs are looked into properly before a decision is made about whether an individual should move to the home. And all professionals who are involved in the individual’s care could be consulted before an admission goes ahead, to make sure the placement would be appropriate. The records describing the care and support people need could be more person-centred, stressing their abilities and strengths, and how staff can support them in maintaining some choice and control of their daily lives. This would help to respect people as individuals with very different needs. Where an assessment of risk of harm is identified, for example the risk from choking, or risk from the environment, then there needs to be a plan in place describing how that risk is to be minimised. This will help to promote a consistent approach from all staff. The way people are supported could be looked at to ensure their privacy and dignity is respected at all times. This includes making sure they are seen by a doctor in private and making sure ladies are properly dressed. All staff could talk to people in a more positive manner and interact in a way that might mean something to the individual. They could explain what they are going to do, before they do it, and they could wait for people to respond to their questions, wherever possible. They could tell people what their meal is before starting to assist them with eating it. This would mean people are being shown more respect. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 8 All staff could know what they must do if they suspect, witness or are told about an incident which may be abusive. They could know that they could inform the local authority directly if they felt unable to approach someone from the company. This increased knowledge could help to keep people safe. Some identified shortfalls, which are needed to protect the health and welfare of people who live and work there could be addressed, so that people can be kept safe. The company could continue to redecorate the home and the corridors to make it more stimulating for the people who live there. And the policy of keeping bedroom doors locked during the day could be looked at according to individual needs and also explained to people and their families in advance of them moving there. This would help to make them aware that the home generally works in this way. 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 Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. Whilst people are assessed prior to moving to the home this is not always done by a person with a professional background, who is better able to assess more complex nursing needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The care records of one person, who moved to the home in the last three months, were looked at. The manager had visited the person at their previous care setting, to determine their care needs and whether they could be met if the decision was taken for the person to move to Sunnyside. The manager explained that as she is not a nurse she would always discuss her assessment with a nurse at the home. Sometimes one of the nurses accompanies her when she does this assessment. It would be much better if a Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 11 nurse was always present though, as they may identify issues that an untrained person may miss. The AQAA, submitted by the manager in advance of the visit, states that the home insists on a local authority assessment before someone from the home visits to carry out their own. This individual, whose records were looked at, was admitted from a sister home of Sunnyside. However the records state that the manager’s assessment was carried out twenty four hours prior to the person moving there and the local authority assessment was faxed to the home on the day they moved in. This does not appear to match with the information in the AQAA. This assessment did describe people’s needs but these could have been expanded on, to clearly identify what the person could do for themselves still, which would enable them to stay in charge of their lives a little. This sort of information helps staff to recognise and support people as individuals. No-one at the home was able to recall their admission process. However four relatives, who filled in the surveys on their relative’s behalf all said they were given enough information about the home, before their relative moved there. Three people said they visited the home first before deciding whether their relative should move there. The home has a Statement of Purpose and service user guide, which have been revised earlier this year and which are displayed in the entrance area. The home has a brochure for giving to people who may be interested in moving there, but there were none available to look at. Sunnyside does not provide intermediate care. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. Whilst people’s health and personal care needs are generally well met, some of the underpinning records are not written in a person-centred way. People are not always supported in a way that respects their privacy and dignity. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the random inspection in January 2009 two care plans looked at provided good detail of people’s needs. There was good information about individual’s communication needs and a description of what triggers mat cause someone to become upset. The atmosphere in the home was calm and relaxed. Two care plans were looked at in detail during this visit and several more to check for specific information. These records are needed to describe the care Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 13 and support that people need and for care staff to check that they are providing the right care. The quality of these records varied somewhat. One person had been at the home for more than a year and their care plans contained quite detailed information about the help they needed. However they did not emphasise even the small tasks that the person can still do for themselves. If this information isn’t written down then care staff may ‘take over’ and prevent people maintaining these skills for as long as possible and staying in charge of their lives a little. The other care plan did not provide enough detail, to show how one person is different to the next. People’s strengths and abilities need to be recognised so that the care they receive is individualised. For example one care plan stated that the individual liked a weekly shower, but did not say enough about their preferences and abilities when getting showered. Although people had a ‘preference plan’ about their likes and dislikes this was not always completed and standard statements were used on several parts of the record. This does not promote individualised person-centred care. There were assessments of risk to the person from falling, developing pressure sores or becoming malnourished. An assessment was completed for helping people to move around the home, but this was not in enough detail, so an unfamiliar carer would not know what support was needed. One person was identified as at risk of choking, but there was no assessment in place as to how that risk was to be minimised. One carer though was spoken with and they were very clear about what they needed to do in that situation. However this needs to be written down as other carers may not be so sure. Another record said that one individual has to be supervised at all times when eating, however on the first day of the inspection, although carers were in the same room they were carrying out other tasks, so this person was not being closely monitored. There also needs to be detailed information about how people communicate. Care plans need to describe how to recognise whether an individual is happy or sad, as several people living at Sunnyside would not be able to speak about how they are feeling. This can help staff to more easily identify if someone is troubled by something, so that they can try to work out what this might be, so that it can be put right. People’s records were kept in three different files and information was difficult to find. The manager said she had recognised this was a barrier to effective communication and the nursing staff also felt things could be improved. The Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 14 way the care plans were to be put together was to be reviewed with some urgency. People’s healthcare needs are well met. There are detailed records of guidance from community professionals like the family doctor, speech therapist, dietician and physiotherapist, as well as specialist mental health teams. The unexpected events at the home on the first day were managed in an appropriate and professional manner. A visiting healthcare professional spoken with confirmed that staff referred appropriately and followed the guidance given. One person had had a number of falls in May and they had been referred to a specialist team who had already visited and made suggestions to try to reduce these incidents happening. Medication systems at the home are good. Random checks showed that the records are well maintained and regular checks are carried out to ensure that people are receiving their drugs appropriately. The nurse on duty showed a good knowledge of medication practices at the home. One carer spoken with explained how their work showed that they protected people’s privacy and dignity. They stressed the importance of explaining what they were going to do, before they carried out a manoeuvre, even if the person couldn’t respond. And they commented that it was important to always knock before entering a person’s room and to provide personal and intimate care in a respectful manner. However a doctor visited a person over the lunchtime period and was allowed to examine the individual’s leg in the lounge, where other people were present. Although the individual did not want to go to their room, a screen at the very least could have been used to provide some privacy. And many of the ladies at the home do not wear socks or stockings. If this is their choice, then this needs to be recorded in their plan of care. Otherwise people should be properly dressed during the day. Neither of these examples promote people’s dignity. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. Whilst people’s day to day lives are becoming slightly more interesting the way some staff interact with them may prevent them from making choices and retaining some control of their lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People are generally supported to live their lives as they choose and the home promotes a flexible approach to care. People looked generally well cared for, though many of the ladies had bare legs and the records looked at did not state that that was their choice. The care records also need to describe in greater detail how people would choose to spend their time if they could be consulted, so that care staff can tailor their support accordingly. The surveys, completed with help by the Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 16 people living there and by relatives on their behalf all state that the staff ‘always’ listen and act on what they say. One person wrote that their relative hardly said anything now, but that staff ‘do look out for them’. People are encouraged to move around the home as they choose. Some people are unable to walk around without help and carers were generally available to discreetly supervise people and make sure they were kept safe. An activities organiser now works at the home for seventeen hours each week. She has been supported to attend training sessions to provide her with ideas for activities that people living there may benefit from and enjoy. She has started keeping records of activities she has done with people, mainly on a one-to-one basis. These include looking at a magazine together, reading a book, walking out into the garden and hand and nail care. However on the first day of the visit four people were sat in a lounge on their own. There were no staff present and the people were just sat there, with nothing to occupy them. A carer visited the room a couple of times, but did not interact with them in a meaningful way. An increase in the activity person’s hours would provide more opportunities to interact with people, to make their lives more interesting and varied. The care records looked at held little information about people’s past lives and interests so it is difficult for staff to know what to talk about, which may mean something to the individual. One visitor brought a small toddler with her and many of the ladies clearly enjoyed that experience. The home should consider using doll therapy as a way of providing comfort and stimulation to some of the ladies living there. The home is also ‘on the waiting list’ to have a regular pet therapy visitor. The manager explained that visitors who bring along their dog are also very popular. A hairdresser visits regularly and religious services are held periodically at the home. Visitors can come at any time, and the visitor’s book confirmed this. People’s bedroom doors are all kept locked, once they have been cleaned so people cannot go to their own room on their own. The manager said this stopped individuals going into other people’s rooms; however this does not promote people’s independence and choice. This way of working needs to be looked at on an individual basis. It should be discussed with families as part of the pre-admission process. It could also be written in the Statement of Purpose and service user guide so that people thinking of using the home are aware of the policy. People are offered drinks through the day; however drinks cannot be left with many of the people because of the risk of spillage. The care plans identify that Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 17 people need to drink plenty to prevent health complications and staff need to be alert to meeting these needs, particularly in the warmer weather. There is a four week cycle of menus. Although most people don’t have a cooked breakfast one carer spoken with knew people’s preferences and records showed that a few people enjoyed a cooked meal then. On the first day one person was being helped with their pureed meal. The carer didn’t know what the meal was. Care staff must know what they are helping people to eat. This demonstrates respect to the individual, as well as helping to identify foods that people like, or don’t like. On the second day the carer knew exactly what the pureed meal was. The meal experience was more positive than at the last inspection. The random inspection in January 2009 showed that changes had been made to the way meals were managed and the whole experience was more organised and better directed. The dining area now is two adjoining rooms, where the men eat separately to the ladies. There are cloth tablecloths and people are offered a choice of drinks with their meal. Staff could be more thoughtful about where people sit in relation to each other so that the mealtime is a positive experience for all the people, who may have very different abilities. Care staff are now generally more alert to the help people may need, and encourage independence with the use of aids and special cutlery. Although plate guards were available for use several people who managed their meal independently may have benefited from using a guard. Another person was given a dessert spoon to eat their pureed meal with, but spilled a lot of food when they tried to put the full spoon in their mouth. People need to be assessed for the support they need at mealtimes. This should be written down so that staff can provide this support in a consistent way. The meal of chicken and dumplings or curry, with fresh vegetables was well received. People seemed to enjoy the rice pudding too. People are asked what they would like, wherever possible, when they sit down for their meal. One person said the food was ‘very good’. The catering staff spoken with had good knowledge of people’s special diets and how to fortify foods to help people to have more calories. A large delivery of fruit and vegetables had come that morning. Home baking was in the fridge as well as specific foods, bought for an individual to meet their specific cultural needs. Staff confirmed that people were offered pieces of fruit as well as biscuits with their drinks. It would be good practice to let people choose their own biscuits at this time, though rather than staff making that decision. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. Whilst complaints are taken seriously and addressed properly staff’s lack of understanding about safeguarding processes may mean that people may not be being kept safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The complaints procedure is displayed in the entrance area of the home and is included in the written information given to people’s relatives when an individual moves to the home. This information could also be presented in a much simpler format, using pictures and signs, and displayed in a place where people living there could look at it so that those people with some understanding would know what to do if they were unhappy. Most of the surveys completed by people living there, with the help of a second person said they did not know who to talk with if they were unhappy. Relatives though were aware of the complaint’s process. Many people living at the home would be unable to explain if something was bothering them, so it is important that staff are alert to changes in people’s behaviours and what these changes may signify. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 19 There have been three complaints to the home since the last inspection. These were all dealt with by the previous manager. They were all verbal complaints, which were dealt with informally, however it would be good practice to get the complainant’s signature to confirm that they are satisfied with the way their complaint has been handled. The commission has not received any complaints in that time. The home’s training record states that all staff have attended safeguarding training earlier this year. Two carers spoken with confirmed that this was the case. There have been several safeguarding referrals made in the last year, where one person was put at risk by the behaviour of a second person. These were all reported promptly to the local authority and to the commission. When questioned though, whilst two carers knew to report a suspected safeguarding incident to the manager, they were unclear what needed to be done if they were given information about an event that they hadn’t witnessed. They also knew that an allegation about the manager still needed reporting, but they weren’t sure who to. One nurse said that they would investigate any allegation that was reported to them. Although there is information about safeguarding processes displayed in the staff room, staff show a lack of understanding about their responsibilities should they witness or suspect an abusive incident. Staff need to have clear direction about what must be done in these circumstances and they also need to know that the local authority have the responsibility to investigate these allegations and that they can go directly to them, if they feel unable to speak with any managers at the home. All staff have a responsibility to keep people safe and a robust understanding of what to do in a variety of scenarios, where abuse is suspected, would help to promote that safety. A small number of people, who do not have family, now have external advocates. This is good practice and means that people with no visitors still have someone who will make sure their best interests are always being considered. And recruitment processes at the home are robust, ensuring that staff do not work at the home until proper checks are completed to make sure they are suitable to work in a care setting. Good recruitment systems help to keep people safe. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. Whilst the home is clean, comfortable and adapted for people living there, it is not particularly homely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is a large old detached building on the outskirts of Dewsbury, with attractive picture windows overlooking the garden. It was noted to be clean and tidy, though not particularly ‘homely’. A keypad is used to gain access. The company have applied for planning permission, so that they can improve access to the home. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 21 The accommodation is mainly single rooms, though there are four shared rooms. Most bedrooms are on the first floor and there is a vertical passenger lift and a stair lift to reach this floor. The private rooms looked at had been personalised with photographs and other items that meant something to the individual. There are no call bells in use in the bedrooms, though pressure pads are used for a lot of people. These are mats that are placed at the side of the bed. If the person gets out of bed in the night and steps on the mat, this activates an alarm away from the room. Staff can then respond to people as necessary. The doors to people’s rooms are numbered, but are otherwise identical. This does not help people to recognise their own rooms. Some changes have been made since the last inspection to the way the communal rooms are used. A separately staffed unit within the home has been incorporated into the main home, which has enabled a third lounge area to be created. One of these lounges is now used as a quiet area, for people who don’t want the television. The dining areas have been moved and two lounges have been redecorated. One is now partly carpeted. Despite these changes, the mainly vinyl flooring and lack of homely items in these communal areas still make the home feel quite institutional. However one relative commented in their survey that ‘the place is much better since the carpets were removed and other flooring put down’. There is an outside safe area with decking, but this is away from where people seem to spend their time, so will not be well used unless carers accompany people there. Signs are used to promote people’s independence; however pictorial ones, for example a picture of a large toilet, or bath, may be easier for people to recognise. Sunnyside has a corridor system where people can walk around and find themselves back where they started. The manager states that she is waiting for sound activated fire door closures to be fitted, which will enable fire doors on this ‘circuit’ to be kept open. The manager should consider taking advice from dementia specialists about how to make the corridors more interesting to encourage people to walk around. Some fire extinguishers are stored in tamper-proof containers, however the extinguishers were very difficult to remove and this could affect people’s safety in an emergency. The managers should take advice from a fire officer about the best way for this to be managed. There were no unpleasant smells noted in the building. Staff were observed using protective wear when helping people with personal care. The laundry room floor is very uneven and although the manager says it has been repainted since the last inspection the paint is still cracked and chipped in Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 22 places. This does not provide a surface that is easy to keep clean and minimise the risk of a spread of infection. The senior manager says that the company is looking into moving the laundry out of the basement into a more suitable room, but there are no timescales in place for this to happen. The manager must have a very robust assessment in place to state how the home is managing this risk and thereby protecting the health and safety of the people who live and work there. At the last inspection the laundry room had very large amounts of fluff from the tumble dryer on the various pipes. Whilst this volume has been removed the pipes and other horizontal surfaces need to be cleaned regularly to ensure the room is kept as clean and hygienic as possible. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. People are cared for by attentive and well recruited staff, whose morale is improving following recent management changes at the home. Some care staff may need more training to help them to meet people’s needs well and keep people safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a trained nurse working at Sunnyside at all times. Both general and mental health nurses are employed. The rota confirmed that generally five carers work the early shift, four the late shift and two through the night, to support the nurse. This is for 25 people currently living there. One carer works as an activities person for seventeen hours each week, which helps to make people’s lives more interesting. There are both male and female care staff employed, so that people’s preferences about whether they receive personal care from male or female staff can be respected whenever possible. There are currently no staffing Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 24 vacancies so agency staff are now rarely used, though more than eighty care shifts have needed to be covered by agency staff in the last three months. One relative commented in the survey. ‘From what I see the staff treat my relative well. Staff make a big difference to a place and I can’t fault any of them’. There are also catering, domestic and laundry staff working every day. And maintenance men, employed by the parent company visit each day to carry out routine maintenance checks. Visits to the home on two separate days meant that the interactions of a good number of staff could be observed. These observations varied greatly. Whilst some staff showed good communication skills, crouching down and using nonverbal communication and touch, as well as speaking with and listening to people, other experiences were not so positive. For example one carer entered the lounge, said ‘everything alright?’, then walked out. They offered a drink to one person but not to the other people in the room. On another occasion two carers entered the room with a wheelchair and said to an individual ‘you’re going in another lounge. It’s too cold here’. There was no attempt to see if the individual wanted to move, or even if they felt cold. These interactions were discussed with the managers. Although staff attend training in dementia care and managing behaviour that challenges the service, some people are not having their needs well met because of the way the staff respond to them. The layout of the home means that people sit in a number of communal areas. People are often not able to call for assistance and it is difficult for staff to keep an eye on everyone. The manager needs to keep the staffing levels under review to ensure there are enough staff working to meet people’s changing needs. The home employs a number of care staff whose accents may be difficult for some people to understand. The manager and staff need to be alert that people may become more frustrated and upset if they don’t understand what is being said to them. The rota must ensure that someone with good communication skills is always on duty and that staff ask for help from a colleague promptly if people have difficulty either understanding instructions, or making themselves understood. Eight out of thirty care staff have a minimum Level 2 National Vocational Qualification in Care. Another ten have been enrolled on the course. This helps to provide staff with good up to date training, which meets recognised standards. It also help staff to work in a safe, consistent way when providing people with care. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 25 Recruitment processes at the home are robust. People have checks completed before starting work there. One staff member started work before their police check was back and the manager contacted the commission to explain how this person was to be supervised in their work until the police check was available to look at. Good recruitment systems help to keep people safe. The manager keeps a training record so that she can check that this is provided, and that staff attend in a timely way. This record states that generally compulsory training is up to date and care staff spoken with confirmed that. However people’s knowledge about abuse was ‘sketchy’ although they had attended safeguarding training. The manager needs to be satisfied that the training programmes that are used provide the right information and that staff’s knowledge improves as a result of the event. One nurse spoken with said they had attended a couple of study days in the last year, which helped with their clinical skills. The home must continue to support nurses in their personal development so that they have up to date knowledge and skills to use at the home. Staff follow an induction programme which has been developed by Skills for Care. This ensures new staff receive a planned induction so that they can learn how to work safely and effectively. Evidence of these, as well as certificates for training attended, were seen in one staff file looked at. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. The lack of consistent management in recent times has had a negative effect on the quality of service provided. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Over the last two or three years there have been a number of different managers working at the home. This has affected the stability and morale of staff at the home, as they have had to keep making changes to the way they Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 27 work, depending on who was in post. The last manager left her position earlier this year and a new manager has been appointed, but is waiting for recruitment checks to be completed before starting work. Comments from staff in their surveys include ‘there is now good communication between nurses, carers and the manager. I feel that we have reached a stage, which is a pleasant and happy environment to work in’. Another said ‘the home would do better if a manager stayed for a longer time and managed the home properly’. And one member of staff spoken with agreed that the home ‘needed some stability after lots of changes recently’. In the interim a temporary manager, who is the registered manager of a sister home to Sunnyside, is working at the home. The company plans for her to work alongside the new manager to start with. And the new manager needs to apply to be registered with the commission to confirm his fitness to manage a care home. The home asks families to complete a series of questionnaires each year on how the home is running. The results are displayed in the entrance area and are generally positive. A residents and relatives meeting was held in the last few weeks, but this was poorly attended. The management may need to look at different ways of involving families in contributing to how the home operates. Whilst people living there may not be able to talk in detail about how the home runs, staff could try to note down things that people seem to enjoy or things that make them more upset. This knowledge could then influence the way staff support them. The manager should try to get the views about the home from community professionals so that they can say what changes they’d like to see. All these comments should help to influence how the home operates. People’s monies are stored securely and two financial records looked at showed that the actual monies tallied with the written records. Details of accidents and incidents are kept and audited each month to check whether similar incidents are happening to the same people. Information about serious incidents have been sent to the commission promptly, as is required by law, so that these can be monitored. A senior manager visited the home in May to carry out his own checks that the home is running well. The last visit recorded was more than a year ago. These unannounced visits need to happen each month and written records be kept so that checks can be made by managers, and other authorised people, that previously identified issues have been sorted. There are a range of health and safety policies and procedures in place and a random number of safety certificates were checked and found to be in date. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 28 The home has made proper provision to ensure that there are safe working practices by providing staff training in first aid, fire, food hygiene, infection control and safe moving and handling techniques. Both the environmental health officer and fire officer have visited in the past year. Both are satisfied overall with the way the home operates. However some shortfalls were identified and these need urgently addressing in order to protect the welfare of people living and working at Sunnyside. At the last inspection ten months ago it was noted that bedrails were not fitted correctly on the bed. This has not been sorted. People are at risk of serious harm because they could get their head trapped between the end of the bedrail and the head of the bed. The manager arranged for the position of all bedrails in use to be checked immediately by the nurse. However the home needs to have robust systems in place to ensure they remain correctly positioned and the manager needs to be auditing these systems. Hot water taps, which people have access to, are only checked every three months. The manager needs to be satisfied that this level of monitoring is sufficient to protect people from the risk of scalding. One temperature was recorded as 31°C, which is rather cold. Although this was identified as being too low, there was no evidence that the temperature had been re-checked. Fire safety checks are carried out regularly however a fault was identified with the emergency lighting in May and the fault was still there when it was checked again a month later. When maintenance staff carry out routine checks they must report shortfalls so that they can be addressed. And the manager needs to audit maintenance records to be satisfied that these checks are being carried out properly. The manager immediately arranged an urgent visit from an electrician to deal with the fault. There were prepared foods stored in the fridge, which were not dated. Foods need to be labelled as to when they were made so that catering staff know when the food needs to be thrown out. This prevents food being mistakenly given to people when it may no longer be fit to eat. Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 13 Requirement Timescale for action 30/06/09 2. OP8 13 3. OP10 12 4. OP18 13 When an assessment identifies risk of harm then there must be a care plan describing how that risk of harm is to be managed and minimised. This will help to promote people’s safety as well as ensuring they receive consistent care. People who are assessed as 30/06/09 needing close supervision at mealtimes because of the risk of choking must be provided with that support, in order to keep them safe. To ensure people’s privacy and 30/06/09 dignity is always respected 1) People must be seen in private by a health or social care professional. 2) Ladies must wear their own clothes, to include socks or stockings when dressed, unless it is written in their care plan that they do not like wearing these items of clothing. All staff working at the home 31/07/09 must know what to do if they think an abusive incident has DS0000045066.V375440.R01.S.doc Version 5.2 Sunnyside Nursing Home Page 31 5. OP26 13 6. OP30 18 7. OP38 13 8. OP38 23 9. OP38 13 occurred at the home. This will help to keep people safe. There must be a written assessment of risk of harm of a an outbreak of infection caused by the laundry room floor not being cleaned properly because of its poor state. This will help to keep people who live and work there safe. The manager must ensure that care staff have the training and understanding of dementia care needs so that they can communicate both verbally and non-verbally in an appropriate and sensitive manner. Bed rails need to be fitted to the bed, checked and maintained according to MRHA (Medicines and Healthcare products Regulatory Agency) guidelines. This will help to keep people safe. Previous timescale of 07/01/09 not met Fire safety systems must be kept fit for purpose and faults repaired with urgency. Doing this help to keep people safe from the risk of fire. Prepared foods must be labelled to say when they are to be thrown out. This helps to make sure people aren’t given food that may not be fit to eat. 31/07/09 30/09/09 30/06/09 30/06/09 30/06/09 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 Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 32 1. OP3 2. OP3 3. OP7 4. OP12 5. OP14 6. 7. OP15 OP19 The manager should make sure she gathers information from other professionals involved in an individual’s care, including a care management assessment before making a decision that an admission can take place. This will help to prevent placements breaking down because a person’s needs cannot be met at the home. It would be good practice for a nurse to carry out an assessment of people’s needs in advance of them moving to the home, so that all their needs can be looked into by someone with the professional knowledge to identify more complex needs. The care plans could be written in a way that enables people to maintain independence and describes in detail what they can and can’t do. The record should include a care plan about every care need so that people receive support in a consistent way from all staff. Consideration should be given to increasing the hours of the activities organiser so0 that she can develop her role and provide more one to one time with people to make their lives more interesting. The practice of keeping people’s bedrooms locked during the day should be looked at on an individual basis and discussed in the pre-admission process so that people know that this is the policy followed by the home. People should be treated in a respectful manner, by being informed about their meal by a carer, before they start providing assistance. There should be continued effort to make the communal areas more homely and to decorate the corridors making it more interesting for people as they walk round the home. The manager should apply to be registered with the commission to confirm that he is fit to carry out his duties. The manager should satisfy herself that a three monthly cycle of checking the hot water temperatures of taps to which people living there have access to, is sufficient to minimise the risks of them being scalded by water that is too hot. 8. 9. OP31 OP38 Sunnyside Nursing Home DS0000045066.V375440.R01.S.doc Version 5.2 Page 33 Care Quality Commission St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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