Care Home: Sunrise Operations Bramhall II Limited (Assisted Living)

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What the care home does well People were given information about the home and, wherever possible, their needs were assessed before they moved in. This meant that they knew that their needs could be met. One person`s relative said that the admission process was, "very organised", and concluded that, "the whole process of admission was extremely good". Each care plan we saw was written from the point of view of the person receiving the care, as if they themselves had written it. This meant that the dignity, independence and choice of people was reflected in their care plans. The way that people were supported to take their medication was good. In particular, the senior wellness nurse regularly observed and assessed staff when they were administering medication to people, to make sure that they were always competent and that people were given their medication safely. All the people and their relatives spoken to were pleased with the standard of care at the home. One person`s relative said that staff, "looked after (people)", and that, "nothing is too much trouble". One person who used the service said, "the attention you get is very good", and that the staff, "fall over themselves to be helpful, they really do". All four people who filled in a survey said that they always, or usually, received the care and support they needed and that the staff listened and acted on what they said. People were pleased about the way that the staff respected their privacy. One person said that staff, "always asked what name they can call you, they don`t make assumptions". Another person talked about the sensitive way that staff helped them with personal care and concluded, "they`re very good at that". Planning and providing activities was a strength of the service. All four people who filled in a survey said that there were always activities arranged by the home that they could take part in. One relative was very pleased with the way that staff encourage people, "to join in things", and that fact that people were "included in the community". People were happy with the food at the home. We saw that people had a wide range of choices, were served food in a pleasant environment, were served wine with their meals, could have a meal with visitors and could obtain drinks and snacks at the bistro 24 hours a day. All four people who filled in a survey said that they either always, or usually, liked the meals at the home. We saw that visitors were made very welcome at the home, were greeted by a friendly member of staff and were offered a drink. A person`s relative we spoke to said that this was always the case. This is good as it enables people to maintain their relationships with family and friends. People lived in an environment that was spacious, warm and comfortable and was decorated and furnished to a very high standard. We saw that the home was very clean and one relative said, "the place is spotless, you can`t fault that". One person using the service said that the home was, "kept in perfect condition". People were happy with the staff. One person`s relative said that the staff were "absolutely fantastic". People using the service said that nothing was too much trouble for the staff. One person who filled in a survey said that staff were, "extremely polite" and that there were, "excellent staff, from top to bottom". A visiting healthcare professional concluded that, "the staff are very professional in their manner, the way they speak to you, and the way they speak to people who live here". People and their relatives were happy with the manager, who we observed to be respectful and professional when helping people. Staff said that the Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 8manager was good and approachable. One person receiving the service concluded that they were, "happy here", and added, "frankly, we cannot see any future that is going to be better". All the people, and their relatives, who were asked about complaints said that they always knew who to speak to if they were not happy and that they knew how to make a complaint. One relative said that they would not hesitate to approach the manager with a problem. What has improved since the last inspection? This was the first inspection of this service. What the care home could do better: Although the outcomes for people using the service were good, the following improvements needed to be made: The manager needed to make sure that care plans and risk assessments always contained detailed information about what the staff needed to do to support and safeguard a person. The manager needed to always record the outcomes of complaints, so that any patterns in problems could be seen. The manager needed to obtain a copy of the local authority`s protection of vulnerable adults procedure and ensure that this procedure was followed to protect people. The manager needed to make sure that when recruiting staff, any gaps in potential staff`s employment history were checked so that people using the service were always protected. The manager and a senior manager demonstrated to us an open and professional approach to making these improvements in the interests of people using the service. CARE HOMES FOR OLDER PEOPLE Sunrise Operations Bramhall II Limited (Assisted Living) 1 Diaryground Road Bramhall Stockport Cheshire SK7 2HW Lead Inspector Helen Dempster Unannounced Inspection 24th February 2009 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunrise Operations Bramhall II Limited (Assisted Living) 1 Diaryground Road Bramhall Stockport Cheshire SK7 2HW 0161 440 2200 Address 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) bramhall.alc@sunriseseniorliving.com Sunrise Operations Bramhall II Ltd Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (72) of places Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing- Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP The maximum number of people who can be accommodated is: 72 Date of last inspection N/A Brief Description of the Service: Sunrise Operations Bramhall ll Ltd (Assisted Living) is a care home with nursing, which was registered on 22nd of October 2008 to provide accommodation and care to 72 older people. The service shares a premises with Sunrise Operations Bramhall ll Ltd (Reminiscence Neighbourhood). The Reminiscence Neighbourhood service provides accommodation and personal care to 26 people who have dementia. While the two services share a premises and some facilities, they each have their own manager, staff and entrance. The premises that both services share is a detached, purpose-built building, located near the village Bramhall, close to bus and rail services to the city centre of Manchester and surrounding areas. The area has a range of all the usual services, including shops, banks, post offices, public houses, restaurants etc. All accommodation is in single occupancy suites, which have an ensuite shower or bath. There is a wide range of communal areas, including a large dining area, a number of lounge areas and a bistro which serves tea and coffee and snacks 24 hours a day. Communal and private accommodation is decorated and furnished to a very high standard. People using the service are actively encouraged to bring their own personal effects, including furniture for their room, so that they feel at home. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 5 The range of fees charged by the home are from £420:00 per week to £1400:00 per week. These fees are for accommodation and food and do not include fees for personal care. The level of care each person needs is assessed on admission and is charged for at the rate of £20:00 per hour. Additional charges are made for personal items, including toiletries. Information about the service can be obtained from the service user guide. This is a booklet which provides information to people considering using the service about what the service has to offer. Alternatively, information can be provided from the manager, by telephone, or in person. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this care home is: two star good service. This key unannounced inspection, which included a visit to the home, took place on Tuesday 24th February. The manager and staff did not know that this visit was going to take place. This was the first inspection for this service since it was registered in October 2008. Prior to the inspection, we sent surveys out to people who use the service and staff to ask what they thought about the service. Three members of staff and four people who use the service returned their surveys. Comments from these surveys are included in the report. We asked the manager of the service to complete a form called an annual quality assurance assessment (AQAA). This form gave the manager the opportunity to tell us what they felt they do well and what they need to do better. This helped us to determine if the management of the service see the service they provided in the same way that we saw it. We would have liked the form to contain more detailed information about the service and what plans there were to develop the service. All of the key inspection standards were assessed at the site visit and information was taken from various sources. This included observing care practices, talking with people who use the service, their relatives, the manager, a senior manager and other members of the staff team. The care of three people was looked at in detail to learn about their experience of the service from when they first used it to the present-day. A selection of records were looked at, including medication records, training records and care records. What the service does well: People were given information about the home and, wherever possible, their needs were assessed before they moved in. This meant that they knew that their needs could be met. One persons relative said that the admission process was, very organised, and concluded that, the whole process of admission was extremely good. Each care plan we saw was written from the point of view of the person receiving the care, as if they themselves had written it. This meant that the dignity, independence and choice of people was reflected in their care plans. The way that people were supported to take their medication was good. In particular, the senior wellness nurse regularly observed and assessed staff Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 7 when they were administering medication to people, to make sure that they were always competent and that people were given their medication safely. All the people and their relatives spoken to were pleased with the standard of care at the home. One persons relative said that staff, looked after (people), and that, nothing is too much trouble. One person who used the service said, the attention you get is very good, and that the staff, fall over themselves to be helpful, they really do. All four people who filled in a survey said that they always, or usually, received the care and support they needed and that the staff listened and acted on what they said. People were pleased about the way that the staff respected their privacy. One person said that staff, always asked what name they can call you, they dont make assumptions. Another person talked about the sensitive way that staff helped them with personal care and concluded, theyre very good at that. Planning and providing activities was a strength of the service. All four people who filled in a survey said that there were always activities arranged by the home that they could take part in. One relative was very pleased with the way that staff encourage people, “to join in things, and that fact that people were included in the community. People were happy with the food at the home. We saw that people had a wide range of choices, were served food in a pleasant environment, were served wine with their meals, could have a meal with visitors and could obtain drinks and snacks at the bistro 24 hours a day. All four people who filled in a survey said that they either always, or usually, liked the meals at the home. We saw that visitors were made very welcome at the home, were greeted by a friendly member of staff and were offered a drink. A persons relative we spoke to said that this was always the case. This is good as it enables people to maintain their relationships with family and friends. People lived in an environment that was spacious, warm and comfortable and was decorated and furnished to a very high standard. We saw that the home was very clean and one relative said, the place is spotless, you cant fault that. One person using the service said that the home was, kept in perfect condition. People were happy with the staff. One persons relative said that the staff were absolutely fantastic. People using the service said that nothing was too much trouble for the staff. One person who filled in a survey said that staff were, extremely polite and that there were, excellent staff, from top to bottom. A visiting healthcare professional concluded that, the staff are very professional in their manner, the way they speak to you, and the way they speak to people who live here. People and their relatives were happy with the manager, who we observed to be respectful and professional when helping people. Staff said that the Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 8 manager was good and approachable. One person receiving the service concluded that they were, happy here, and added, frankly, we cannot see any future that is going to be better”. All the people, and their relatives, who were asked about complaints said that they always knew who to speak to if they were not happy and that they knew how to make a complaint. One relative said that they would not hesitate to approach the manager with a problem. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.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 Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given information, and, wherever possible, have their needs assessed before moving into the home, so they know that their needs can be met. EVIDENCE: Wherever possible, people who used the service received information prior to their admission to allow them choice. This included providing a copy of the service users guide, which is a booklet which has lots of information about the service. All four people who filled in a survey said that that they had received enough information about the home before they moved in so that they could decide if it was the right place for them. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 11 The manager explained that the initial assessment is completed at least two days before admission. The manager added that sometimes the assessment is continued following admission. We saw that the exception to this was the occasions when people were admitted for periods of care as an emergency admission. The relative of one person we spoke to talked about the emergency admission of their parent. This relative said that much of the assessment took place on admission. The relative said that this process was, very organised and that all the staff were, extremely welcoming”. This relative concluded that, the whole process of admission was extremely good”. In the AQAA, the manager stated that, we ensure that residents benefit from a thorough and thoughtful ‘move-in’ process. This process supports the resident’s needs, while achieving minimum disruption and distress for the individual”. We saw that the preparation for people moving into the home included obtaining as much information about what was important to them as possible. One example of this was described by one persons relative who explained that before this person was admitted, they were given a number of forms that the person could fill in with the support of their relatives and friends. The forms were designed to obtain as much information as possible about the person’s past life, employment history, social history, hobbies and interests, family life, friends that are important to them etc. We saw that copies of these forms were held on the files of people we looked at, and that the information was used to form the care plan. This is good for the person, as it enables staff to understand and respect what was, and is, important to individuals in their lives. Staff we spoke talked about having enough information, and time, to meet peoples needs. In particular, all three staff who filled in a survey said that the way that information about people is passed between staff always works well and that they always have the right support, experience and knowledge to meet the different needs of people. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples health and personal care needs were met in the way they preferred and with respect for their privacy, dignity and independence. EVIDENCE: In the AQAA, the manager stated that, during the assessment process, information is gathered from the resident and their family. An individual service care plan is written enabling us to deliver care that recognises the importance of the resident’s right to choice, privacy, dignity and independence. To assess whether this was the case, we looked at the care plans for three of the people and talked to people, their relatives and staff. The three care plans we saw were written from the point of view of the person. This was done by writing the care plan as if the person themselves were writing it. Examples included, I like a bath or shower daily, I am able to Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 13 choose my own outfits, but need assistance to dress, and please approach me with a smile and a stroke on the hand. This meant that the dignity, independence and choice of people was reflected in their care plans. People who used the service did feel that staff respected them. One person said, I think they respect us. This person gave examples of this, including the fact that staff, “always ask what name they can call you, they dont make assumptions. Another person talked about the way that staff helped them with personal care. This person said that when helping them to go to the toilet, staff, close the door, offer to wait outside, they’re very good at that” All interactions between staff and people who use the service that we saw were warm, friendly, discreet and respectful. Some aspects of care plans and health assessments we saw were detailed and helpful. This included information about people’s nutritional needs/preferred foods, the way that the skin of people should be protected and cared for, and the way that peoples needs change on different days. One example we saw was, I am feeling more confident on some days and should be assessed daily before transferring, as to whether I can transfer with the assistance of a carer, or need to use equipment. We also saw that the day to day notes about peoples progress were detailed and contained information about people’s health, well-being, social activities, mood etc. Care plans we saw included details of each persons physical and mental health, mobility, moving and handling needs, aids and adaptations needed, nutritional needs, medication details and religious beliefs. We found that some care plans were more detailed than others. In particular, some care plans were lacking in detail about exactly what staff needed to do to support the person e.g. to assist them to dress. It was recommended that this detail was always recorded so that staff consistently met each persons needs in the way they preferred and managers agreed to address this. There was a form in place to record risks to people, including the risk of falls. All three of these risk assessments had, “yes” or “no” answers against potential risks, each of which had general information to advise staff of what they needed to assess. Unlike the care plans we saw, risk assessments were not personalised to the individual. For example, the mobilising risk assessment for one person noted, I am at risk of falling, and, my legs are not equal in length and I have an extra sole in my shoe. There was no specific guidance for the staff as to how this impacted on this person’s risk of falling. In particular, there were no details of any control measures that would help to minimise risks. This was discussed with the manager and a senior manager, who both agreed that the risk assessments were too general, and did not always give staff information about how to minimise the risk for each individual. The managers demonstrated a professional approach to this problem and said that the recommendation that risk assessments improve, would be dealt with without delay. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 14 Although there were some gaps in care plans and risk assessments, the outcomes for people were good. People and their relatives who spoke about their care, were all pleased with the way their needs were met. One relative said that staff, looked after (people)”, and that, nothing is too much trouble. One person who used the service said, the attention you get is very good and that the staff, fall over themselves to be helpful, they really do. The four people who filled in a survey were also happy with the care they received. All four people said they always (3), or usually (1), received the care and support they needed and that the staff listened and acted on what they said. The service has a team of wellness nurses, who are responsible for assessing and meeting health care needs. Two of the people who filled in a survey were in receipt of medical support from nurses and both these people said that they always received the medical support they needed. The wellness nurses, and some senior care staff, were responsible for supporting people to take their medication. Medication policies and procedures were in place and staff had received training in the administration of medication. Medication was stored in two separate locked cabinets, secured to the wall of a locked room. We saw that the level of accuracy in the medication administration record was good and balances of controlled drugs were accurate. There were lots of examples of good practices which ensured that medication was given safely. This included holding an information sheet for each person which had basic details including the date of birth, a photograph of the person, information about allergies or swallowing difficulties, any special instructions about administration of medication, copies of patient information leaflets for all medication being taken and details of why the medication was administered. Another good practice was the regular observation and assessment of staff practice when they administered medication by a senior wellness nurse. This ensured that staff continued to be competent in administering medication. We observed that medication was given at mealtimes, in a discreet and respectful way. Only one person managed their own medication. This person said that they self medicated by choice and had a lockable facility to store their medication. We discussed some aspects of the management of medication with the senior wellness nurse. This included the need to ensure that any human error on the medication administration record is not obscured, when amending the record. The service has a homely remedies policy. Where possible, the permission of the GP to give homely remedies to a group of patients they saw was sought collectively. However, it was recommended that on admission, the approval of an individuals GP to administer homely remedies to this person was sought, in writing. A spiral bound notebook was used as an administration record for homely remedies, with loose pages. It was recommended that a more formal Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 15 record, including balances of medication held, was used, with a page for each medication, so that it is clear how medication which is not prescribed is given to each person. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from choices to enable them to exercise day to day control over their lives and enjoy the food of their choice. EVIDENCE: In the AQAA, the manager stated, we have systems in place to identify residents’ choice with regard to routines of daily living, who can visit and when, residents’ personal choice and autonomy and support for residents in the provision of wholesome and nutritious food in a congenial setting and at a time that suits the individual. To assess whether this was the case, we looked at the care plans for three of the people and other records, talked to people, their relatives and staff and had lunch with people using the service in the main dining room. People and their relatives were involved in the assessment process by providing information on a persons hobbies, social history, employment history, family life and their preferred daily routines. We saw that the care Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 17 plans contained detailed information about peoples personalities and preferred activities. Examples included, I am quiet and like my own company, and, “I enjoy my crossword books and enjoy playing Scrabble”. One example of good practice was that each person has a 24-hour calendar included in their care plan. We saw that the 24-hour calendar advised the staff about peoples preferred routine e.g. when they preferred to go to bed, get up, how they liked their tea, what they liked for breakfast etc. This information helped the staff to understand what was important to an individual. Planning and providing activities was a strength of the service. The manager explained that the service employs an activities organiser and at least five activities are planned each day. We saw that these were advertised on a noticeboard, and each person had a personal copy of the diary of planned activities. During the visit we observed people enjoying a pancake making demonstration. The chef talked about the history and origin of the tradition of pancake making, and people found this interesting. People were pleased with the activities on offer. In particular, all four people who filled in a survey said that there were always activities arranged by the home that they could take part in. One relative was very pleased with the way that staff encouraged people, to join in things. This person added that people, are included in the community. We saw that peoples care plans included information about their religious views and whether they wished to attend any churches. One person’s care plan noted, I do not require spiritual input”. We saw that staff aim to support people to follow the religion of their choice and respect their beliefs and choices. Most people had their meals in the main dining room, but could have meals in their room if they prefered. People and their relatives confirmed that staff ensure that they could share a meal together when visiting. When having lunch with three people who use the service, we saw that tables were well laid, there was a menu on the table with a number of choices and that the staff were attentive and discreet when supporting people. The lunchtime and evening meal is a three course meal and people said that the food was good and the atmosphere in the dining room was pleasant. The food we tasted was well presented, hot and tasty. Some people chose to have wine with their lunch, and soft drinks, tea and coffee were also available. All four people who filled in a survey said that they either always (3), or usually (1), liked the meals at the home. Care plans had lots of details of each persons nutritional needs and details of any special diets. This information was also available to the catering staff to ensure that people got the food they needed and preferred. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 18 All the relatives of the people who used the service said that they were always made welcome at the home. One person said that they were, “always offered a drink” and were made welcome. We observed that all visitors to the home were greeted by friendly staff, offered a drink at the bistro, and were supported to find the person they were visiting. This was good at it enabled people to maintain their relationships with family and friends. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were confident that the manager and staff would listen to their concerns and staff training in the protection of vulnerable adults ensured that people were safeguarded from abuse. EVIDENCE: In the AQAA, the manager stated, we provide information on how to make a complaint in our service user guide. We also encourage staff to provide feedback to each other if they observe poor practice. Staff are trained with regard to issues of abuse, neglect and discrimination. To assess whether this was the case, we looked at the care plans for three of the people, other records and talked to people, their relatives and staff. The complaints procedure was seen to be in the service user guide. The outcome of one persons complaint was recorded on their personal file. The manager explained that there had been a number of complaints about the same issue from this person. The manager said that most concerns were dealt with immediately that they happened. The manager added that they did not record all such concerns. It was recommended that a record of complaints, including details of the investigation and outcomes would enable her to monitor any patterns in issues. The manager to agreed to implement this. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 20 All four people who filled in a survey said that they always knew who to speak to if they were not happy and knew how to make a complaint. One person said, if I had a complaint I would go to the manager or the director. This person said that they did feel that their complaint would be taken seriously and added, theres no them and us. The service’s Protection Of Vulnerable Adults (POVA) policy was seen to be accessible to the manager and staff, staff had received training in safeguarding people from abuse and all staff had a personal copy of the organisations policy and had signed to indicate that they had understood it. When discussing possible scenarios, the manager and staff demonstrated an understanding of how to safeguard people from abuse. The manager did not have a copy of Stockport Councils POVA policy. Contact details of the safeguarding contact person at the council was provided and the manager agreed to make contact and obtain a copy of the policy, and training in its implementation without delay. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefited from an attractive, comfortable, warm, clean, safe and well maintained environment. EVIDENCE: In the AQAA the manager stated, the home is well-suited for its purpose and provide excellent and appropriate facilities suitable for residents’ needs. We had a tour of the building and saw that it was furnished and decorated to a very high standard. All communal areas are spacious, warm and comfortable. There is a large dining room, a number of seating areas and a bistro where people can get drinks and snacks 24 hours a day. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 22 People all have a “suite” of varying standards (and costs). All suites have an ensuite bathroom or shower and a kitchen area and many have a fridge. Like the communal areas, furnishings and decoration in suites was of a very high standard. The rooms of the three people whose care we looked at were seen in the company of these people. These people demonstrated pride in their room, they had bought their own personal effects and furniture and expressed satisfaction with their accommodation. Bathroom areas include a luxury spa bath on each floor and accessible toilets are convenient places throughout the home. The home was very clean and people using the service we spoke to said that it always is. All four people who filled in a survey said that the home was always (3), or usually (1), fresh and clean. One relative said, the place is spotless, you cant fault that and added, if you have anything to say to them, they act on it, its not left. The example given was that on one visit this relative noticed that there was no hand cleaner on the door. The relative mentioned it to staff and told us that since that time there has always been one there. The building is new and therefore very little maintenance is needed. However, maintenance staff are employed to maintain the building. One person said that the home was, kept in perfect condition. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from support provided by experienced and committed staff who they trust. EVIDENCE: In the AQAA, the manager stated, “we have robust systems and procedures in place to ensure the recruitment and retention of appropriately qualified and skilled staff in support of the service. To assess whether this was the case, we talked to people, their relatives, staff and managers and looked at the files of the three staff recruited most recently. We saw that staff files were found to be well organised by using clear indexes. Most of the information on staff files was well recorded, appropriate references were sought, a verbal check was made as to the validity of each reference and Criminal Record Bureau checks (CRBs) were being done for all staff. One aspect of the way that staff were recruited needed to improve. This related to the fact that a full employment history was not always taken, so that the manager could identify any gaps in the employment history.The manager Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 24 was advised of the need to consistently check for gaps in the employment record in order that people are protected. It was obvious from the comments of people who use the service who filled in surveys and talked about the staff, that people were very happy with the way that staff supported them. One person’s relative said that staff were absolutely fantastic. People using the service talked about nothing being too much trouble for the staff and comments included that staff were, extremely polite and that there were, excellent staff, from top to bottom. A visiting healthcare professional also spoke highly of the support they received from the staff when they visited their patients at the home. This person said that, staff are lovely and that,staff cant do enough for you. This person concluded that,the staff are very professional in their manner, the way they speak to you, and the way they speak to people who live here. This is good for people who use the service. All the staff we spoke to talked about being happy in their role and having enough time to give people who use the service the attention they need. One member of staff said I enjoy work, I smile all the time, Ive not had a bad day. This member of staff said that one of the best things about the job is that there is good teamwork and added, we get to do activities with residents, its great. Another member of staff said that, staffing levels are really good, we have time to interact, there is no rushing if someone needs longer for personal care” We saw records of the induction process for staff, which was comprehensive. Staff had an individual training record on their staff file and the manager also provided a copy of the training matrix, which showed the training that all the staff have taken part in. Training courses attended by the staff included moving and handling, the protection of vulnerable adults, wellness, activities, housekeeping, customer relations, medication and the whole home approach. We saw that staff had personal copies of policies concerning the protection of vulnerable adults, their terms and conditions, confidentiality, internet use, the General Social Care Council code of practice, health and safety policy, communication policy and whistleblowing policy. All three staff who filled in a survey about the service said that their induction covered everything they needed to know to do the job when they started very well, that they were well trained and that their manager met with them to give them support regularly. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People and their relatives were confident that the manager ran the home in the best interests of people who live there and that their safety and welfare were promoted. EVIDENCE: In the AQAA, a senior manager stated, we have a competent, qualified and experienced manager who demonstrates an open and inclusive management style”. Since the service had been registered in October 2008, the manager had changed. The new manager had applied to be the registered manager for the Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 26 service and this process was been completed. Staff talked about the manager being good and approachable and one persons relative said that they would not hesitate to approach the manager with a problem. We saw that all interactions between the manager and staff and between the manager and people who use the service were appropriate and professional. One person receiving the service concluded that they were, happy here and added frankly, we cannot see any future that is going to be better. We looked at the arrangements for management and security of money belonging to people use the service. We were told that 90 of people pay fees by direct debit which is set up before they are admitted and that the remaining 10 pay by invoice, or by cheque. The manager said that most of the people using the service are supported by their family to manage their money, and that two people have power of attorney. There is a safe where peoples money can be held for safekeeping, to which only the managers have access. A record is kept of money held on behalf of people and receipts are kept for purchases made on a persons behalf. The service has a supply of petty cash, which can be used if someone is going out on an excursion. The person would then be invoiced for this cost. The manager used both informal and more formal quality assurance processes. The informal process included talking to people on a daily basis to ask their opinions and holding management, resident and staff meetings to get peoples views on the way the home was run. We concluded that the views of people influenced the way the service was run. In the AQAA, the manager provided information about maintenance of equipment and health and safety checks undertaken to ensure that people in the home were safe. Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 27 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 In turn page turn 26 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 Score X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that care plans always contain detailled information about what the staff need to do to support a person. This is necessary so that staff can consistently meet a person’s needs in the way they prefer. It is strongly recommended that all risk assessments provide staff with specific details of how known risks aassociated with daily living, including the risk of falls, can be minimised for each individual person. This is necessary to protect people from harm. It is recommended that each individual person’s GP’s approval is sought, in writing, for the administration of ‘homely remedies’. It is also recommended that a more formal record for the administration of ‘homely remedies’ is held, including balances of medication, and a page for each medication, so that it is clear how medication which DS0000072968.V374286.R01.S.doc Version 5.2 Page 29 2. OP7 3. OP9 Sunrise Operations Bramhall II Limited (Assisted Living) is not prescribed is given to each person. 4. OP16 It is strongly recommended that a record of all complaints is held, including details of the investigation and outcome. This is necessary to identify any patterns in complaints and to demonstrate that peoples concerns are always addressed. It is strongly recommended that the manager obtain a copy of Stockport Councils protection of vulnerable adults policy and some guidance/training in its implementation. This is necessary so that people are always safeguarded It is strongly recommended that the manager consistently check for gaps in the employment record of potential staff, in order that people using the service are always protected. 5. OP18 6. OP29 Sunrise Operations Bramhall II Limited (Assisted Living) DS0000072968.V374286.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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