Care Home: Sunrise Operations Bagshot II Ltd

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What the care home does well The home provides an environment in which the service users are able to maintain their independence. The building has been decorated and furnished to a high standard with thought given to different types of both communal and private space. The use of colour plants and pictures around the home has managed to give a homely environment to suit the service users who live there. Service users living here are able to maintain social links in the community and visitors are very welcome. There is a very comfortable area where both service users and visitors can make a drink and sit and chat. This area was well used during the day. It was good that service users have a choice of bedrooms, which vary in size when they come to the home, they are encouraged to furnish and personalise these to the own wishes and preferences. There is a varied programme of activities available on a daily basis, which service users can choose to join in with, the home also has a mini bus and takes service users out on regular outings. The home offers a well-balanced menu, which is home cooked by chefs at the home. However it would be good to see more real choice offered daily regarding the main meal. The service users are offered wine or other drinks at lunchtime and this is all served in a congenial setting overlooking the garden. The home does have residents meetings and a service user said that they feel that they have a voice and are listened too. Another likes the way they have been able to help out when they feel like it, it makes them still feel valued. What has improved since the last inspection? Not relevant as this is the first inspection of this newly registered home. What the care home could do better: Make sure that all service users regardless of there dietary needs or preferences can make a real choice form the menu offered daily Make sure that all medication coming into the building is counted and recorded on the Mar sheet when ever it comes in during the month, and that the ordering system is monitored to prevent a large stocks of medication accumulating. Key inspection report Care homes for older people Name: Address: Sunrise Operations Bagshot II Ltd (Assisted Living) 14-16 London Road Bagshot Surrey GU19 5HN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Hall     Date: 0 3 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Sunrise Operations Bagshot II Ltd (Assisted Living) 14-16 London Road Bagshot Surrey GU19 5HN 01276456000 01276456001 bagshot.alc@sunriseseniorliving.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sunrise Operations Bagshot II Ltd (Assisted Living) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: (1) The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender: Either whose primary need on admission to the home are within the following categories: Old age, not falling within any other category: Physical Disability (PD) (2) The maximum number of service users that can be accommodated is 62 Date of last inspection Brief description of the care home 0 5 Over 65 57 0 Care Homes for Older People Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We agreed and explained the inspection process with the registered manager at the start of the inspection This is a new home and currently has just 19 service users in residence. The focus of this first inspection was to assess Sunrise Operations Bagshot Assisted Living in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. We used a varied method of gathering evidence to complete this inspection, preinspection information such as discussions with the registered provider and any correspondence relating to the home was used in the planning process to support the inspector to explore any issues of concern and verify practice and service provision. The home had completed an AQAA an annual quality assurance assessment Care Homes for Older People Page 5 of 24 questionnaire, which was received prior the site visit to the home. This provided the Inspector with information relating to what the home considers it does well, What they could do better, and plans for the future. Survey questionnaires were sent to the home prior to the inspection and comments from these were also included in the report. Documentation and records were read. Time was spent reading written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, staff rota, training records and recruitment records. The Inspector identified four service users for case tracking, speaking with two of them. This allowed further cross-referencing of the information held in the home pertaining to their care provision. In addition we took a meal with the service users and spoke during the day with others, which gave a good opportunity to judge the quality of care being provided by the home and understand the impact the care provision has on the service users quality of life. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can feel confident that if offered placement at the home. Staff will have the skills and knowledge to meet their needs. Evidence: The manager, confirmed that before any new service user is admitted to the home on a trial period they are assessed. This was supported by the evidence seen on four service user individual files. A comprehensive assessment is recorded during the assessment process, with a summary of their main needs recorded at the end of the document. A service user and another family member confirmed that the assessment had taken place prior to a place being offered at the home. The staff confirmed that only if as a result of the assessment it can be shown that staff are able to meet the needs of the proposed service user is a place offered. Care Homes for Older People Page 9 of 24 Evidence: The service user is admitted to the home for a trial period, during this time the assessment is ongoing. If at the end of this period the service user wishes to stay, and the staff can meet their individual needs, the placement become permanent. The home does not currrently provide intermediate care. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confiddent that they will be competently assessed and supported with regard to their health and personal care needs, with all their needs being provided to their wishes and preferences, recorded on care plans and risk assessments which are kept under review. However staff need to follow the medication procedures to ensure service users recieve the medication as directed at all times. Evidence: Four service user files were sampled, and they included service users who require nursing care, with one who had high care needs and one who was fairly self managing. The files evidenced that service users have a recorded plan of care for staff to follow. Service users and family spoken with confirm that they had been part of the care planning process. It was also evident that information gathered during the preassessment process had been used to formulate the plan of care. The plans of care included their health care needs and clinical nursing tasks, these along with the other elements of care were clearly written. This enabled staff to have a good understanding of their responsibilities in providing care in a way that meets the service users wishes and preferences. The care plans had been reviewed regularly often more than Care Homes for Older People Page 11 of 24 Evidence: monthly. Changes to the plans were made accordingly, if the outcomes were not being met. However, it was recommended that old information be crossed through or a new sheet started so it is clear which instructions for staff are current. Evidence was seen on file that service users are supported in accessing outside health care such as chiropody, opticians and hospital appointments. These visits are recorded and any follow up needs are added to the care plan if appropriate. On the files sampled evidence were seen of risk assessments. These had been undertaken for each individual service user where risks had been identified a risk assessment had been completed. In most cases these had been reviewed, however staff do need to be vigilant and ensure all risk assessments are reviewed in a timely way. Medication is currently being given by the qualified nurse on duty, and medication is taken to service users using a medication trolley. The manager confirmed that currently none of the service users self-medicates. A small audit of medication was undertaken and most medication was found to be correct. However it was noted that medication that had come into the home during the month rather than at the beginning had not been recorded fully on the mar sheet. It was also apparent that PRN medication (when necessary/requested) was being dispensed before the service user had been asked if they required it. Therefore medication not required had to be destroyed, it was recommended that staff speak to the service user first. The protocols for giving PRN medication were seen on file. The medication trolleys are kept securely and the home has appropriate storage for controlled medication. Controlled medication that was checked was found to be correct. The home has a medication policy and procedure in place which staff are following. The manager confirmed that shortfalls in the medication procedure had been recognised during the last regulation 26 visit and that monitoring had been introduced to ensure medication is recorded, administered, and disposed off correctly. It was evident form my observations and from talking with service users that staff treat service users with respect and they feel there privacy is protected. One service users spoken to said they liked the way staff have a joke with them but are careful never to over step the mark. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being supported to make choices and have a wide range of activities available to them. Service users can feel confident overall that they are offered a well balanced diet and will supported to eat their food where necessary. However offering more dishes regarding the main meal of the day would ensure further variety and a real choice from the menu. Evidence: People who live in the home are supported to live their lives as they choose. Routines are flexible. Restrictions are kept to a minimum within a risk management framework. There is a variety of activities on offer such as art and craft, sketching, Bridge, knitting, quizzes and exercise, which they may choose to take part in if they wish. There are three activity coordinators employed in the home. On the day of inspection all three were helping service users on an outing from the home to a sister home in Weybridge for lunch. The lead activity co-ordinator was enthusiastic about her role, and described the different activities (including outings) service users have access to. Individual records are currently not being kept of all activities undertaken or refused by service users. It was recommended that this be recorded in future so the home can make sure all service users have access to activities which suit them. Currently it Care Homes for Older People Page 13 of 24 Evidence: would seem that particularly with trips out it often the same people who speak up first and go. A relative commented that the home is always welcoming to visitors and that staff and management are helpful. The home takes particular care to ensure that food is nutritious and takes account of specialist dietary needs. The range of food available for those service users needs to be increased. Currently the main meal of the day consists of a meal with meat or fish and a vegetarian dish. Vegetarians therefore only get one choice usually. Similarly not all meat eaters like vegetable dishes. It is important as meals are often the highlight of the day for service users, therefore a real choice should be offered, alternatives are available such as omelettes or salads if service users do not like what is offered. The dining room is well laid out with tables attractively set, although service users can choose to take their meals in their rooms. Currently the home only records the amount of food eaten in some daily records kept in the home. It is important to keep a record of what meals have been eaten by service users in the home. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an effective complaints system in place and service users can be confident their complaints will be taken seriously. Service users are protected protected by adult safeguarding policies and procedures Evidence: The home had a written complaints procedure, which was seen. Feedback received and comments made within service users surveys confirmed they were aware of the contents and felt free to voice their concerns. The manager stated that she had not received any complaints, but these would be used to improve the service they offer. The Whistle blowing and safeguarding adult policy and procedures were seen. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training has been provided regarding different types of abuse and staff are aware of how to deal with allegations of abuse. To protect service users the home operates a robust recruitment procedure. Criminal Record Bureau Checks (CRB) has been obtained for all staff. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in a home that provides a safe high quality and homely environment. With a variety of accommodation to suit the service user and very comfortable indoor and well tended outdoor communal areas. Evidence: The home provides a choice of accommodation and this includes, single occupancy bedrooms which have en-suite bathrooms, Companion suites/bedrooms can be occupied by two people who chose to share toilet/bathing facilities. Bedrooms are carpeted and decorated to a very high standard and meet the National Minimum Standards re furniture requirements. Service users rooms are lockable and service users may have their own key. Each service users room has a window which they can open and see out of but is restricted for safety. Each suite has a heater which can be adjusted by the service user. There are also communal toilets with disabled access and spa baths around the building. The communal areas around the home can be used by all service users and include a tastefully decorated dining area, a number of lounge areas, and kitchen area where service users and visitors can make drinks during the day. There are other seating areas about the home that the service users can chose to sit in. Service users and family members spoken said that the home is always very clean and there are never Care Homes for Older People Page 16 of 24 Evidence: any unpleasant smells. One service user showed where activities often take place, as well as there bedroom which was furnished and set out to meet their individual needs. The service users also could see the raised garden from there room which they had helped to plant. There are garden areas which can seen from most of the homes windows, all are well maintained and give a pleasant outdoor space consisting of well maintained planted beds, grassed and paved areas with seating and is accessible to all service users. The site has a laundry which is used by both registered homes on the site for the bed linen, table cloths etc. The home also has its own laundry facilities where service user personal laundry is serviced and service users can use if they so wish. The building was clean and free from unpleasant odours. The home has policies and procedures for infection control, and staff have access to PPE (Personal Protective Equipment) such as gloves and aprons. The home the registered manager confirmed has made sure that it has the equipment necessary to provide appropriate nursing care, with nursing beds, specialised mattresses and other items that may be required. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can feel confident that their care, social and emotional needs will be met by care and nursing staff in sufficient numbers who have the skills, knowledge and training to those needs. Although the home has yet to meet the target numbers of care staff with a National Vocational Qualification. Service users can be confident that they will be protected by the homes robust recruitment policy and procedure. Evidence: The home only opened four months ago and therefore still has a large number of vacancies. The ratios of care staff to service users are determined according to the assessed needs of service users the manager confirmed. Following discussions with the staff, a review of the rota and observations made during the inspection. The Commission were of the opinion that sufficient care staff and nurses were on duty to support service users to meet their personal needs. The home employs a number of ancillary staff who work as cleaners, laundry, cooks, gardener/ maintenance staff. Thus allowing care staff the time to meet the needs of service users. Care Homes for Older People Page 18 of 24 Evidence: The staff training records indicated undertaken training. From documentary evidence seen the standard of staff training was good overall with the majority of care staff completing basic courses, however as staff are new at present the home has not achieved an NVQ (National Vocational Qualification) Level 2 or above care qualification for at least 50 of care staff. Currently five care staff working at the home have the award, and 7 are undertaking the award, this means they are well under the 50 with an NVQ. Evidence was seen that the home has a development a program for all new staff, which meets Sector Skills councils workforce training targets and ensures care staff fulfill the aims of the home and meet the changing needs of service users. The home has a robust recruitment procedure it follows, ensuring the submission of an application form detailing all previous work history, requests proof of identity and copies of qualification certificates, seeks two written references, and confirms work status. All qualified Nurses working at the home on evidence seen are currently registered with the Nursing and Midwifery Council. The home undertakes POVA checks (Protection of vulnerable Adults list), and CRB, Criminal Record Bureau checks to ensure the safety of service users. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that the registered manager has the necessary qualification skills and experience to run the home in a way that promotes their quality of life. They can also be confident that their views and opinions effect how the home is run. Evidence: The manager is a registered nurse and has undertaken an NVQ level 4 in management, these qualifications along with her past experience equip her to manage the home. The home has an inclusive atmosphere and the service users spoken said that they did feel that they were involved in what happens in the home. One service user said that he does have a voice and he feels he is listened to. Another likes being part of what is going on in the home. Care Homes for Older People Page 20 of 24 Evidence: The registered manager is aware of her responsibilities regarding quality assurance and there is a policy and procedure to follow. The home will be sending out questionnaires within the next six months and the feedback will be used to improve the service offered the registered manager stated. There are regular service users meetings taking place which are recorded and confirmed by the service users spoken with. There was evidence that Regulation 26 visits (Statutory documented visits by the provider to monitor standards within the home) are taking place. This requires the provider or the representative to assess the quality of care within the home and ensure that it is meeting with the required National Minimum Standards. Such visits focus on outcomes for service users with regard to quality of care, staffing, adult safeguarding, audits of policies and procedures and that they are followed, staff training, Activities, Health and Safety etc. along with speaking to staff and service users. Where shortfalls highlighted had been recognised during these visits remedial action is being undertaken. The home has developed a health and safety policy to meet health and safety requirements and legislation. Other policies and procedures were seen, these are corporate and they are reviewed on an annual basis. The homes maintenance person ensures that regular checks and servicing of fire safety equipment / emergency lighting is undertaken at the required frequency. Fire risk assessments were in place along with gas and electric safety check certificates. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Make sure that all medication coming into the building is counted and recorded on the Mar sheet when ever it comes in during the month, and that the ordering system is monitored to prevent large stocks of medication accumulating. Make sure that all service users regardless of there dietary needs or preferences can make a real choice form the menu offered daily 2 15 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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