Care Home: Sunrise Operations Knowle Limited

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What the care home does well Detailed and clear pre-admission assessments are carried out by senior staff to ensure that the needs of the people wishing to live at the Assisted Living Neighbourhood can be met. Care plans are in place for all people living at the Neighbourhood. These are detailed and inform staff of the care and support required. All health care needs are met with evidence of people having been seen by the GP, optician and chiropodist being seen in records seen. Residents are care for in a respectful manner and their privacy and dignity maintained. There is varied and stimulating activities available and that residents` wishes and preferences are taken into account. A monthly activity meeting is held for residents to be involved. Visitors are made welcome and their needs considered. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives. There is a varied and interesting menu that includes themed days each month, for example there had been a Mexican day on the day before our visit. The menu has a four weekly cycle which each revised each season in order to be able to use seasonal foods. People spoken with said that they enjoyed the meals. Links are maintained with the local community with a Ladies Day held at the Neighbourhood to which people in the local community are invited. There have been other links with the neighbours choosing the names of the two buildings on site and local schoolchildren entering a competition to name the dogs that belong to the home. People know how to make a complaint and who to talk to if they had any concerns. A complaints log is maintained, which shows that complaints are addressed appropriately. The Assisted Living Neighbourhood provides a high standard of accommodation with attractive decor, furnishing and fittings throughout. Private accommodation is varied, consisting of different types and sizes of suites, all of which are larger than the required size and have en suite facilities. There is a private and attractive dining room where residents can entertain their family and friends and which can be hired free of charge. There is a charge for meals taken by them. They can also join the resident for meals in the main dining room. Appropriate equipment is provided to assist with specific needs, such as aids for visual impairment and discreet handrails to offer support for people with their mobility around the home.The Neighbourhood was clean and free of offensive odour in all areas visited. A resident commented in a survey that there was an exceptionally high standard of cleaning and room services. There are good infection control systems. There are sufficient staff to meet the needs of the people living in the Neighbourhood. Recruitment practice is robust and minimises the risk of the employment of unsuitable people. Sunrise induction training that is in line with Skills for Care is undertaken by all new staff. Monitoring and auditing of the service and practices takes place to ensure that all services operate in the best interests of residents. There was evidence that equipment is regularly serviced and maintained and that health and safety checks are carried out and all mandatory training related to health and safety is undertaken. All in house checks on the fire system were up to date. Fire training and fire drills were also up to date. Health and safety practice protects residents and staff at the home. What has improved since the last inspection? This is the first inspection for this service. What the care home could do better: The complaints procedure should be displayed where it can be seen by residents and visitors. Some comments in the surveys returned to us indicated that there was some dissatisfaction with the meals. This needs to be monitored to assess if this is an on going issue and any necessary action taken. Internal and external medication should be stored separately. All creams, ointments and drops should be dated on opening to ensure that they are disposed of before they are no longer stable. Fabric towels in the communal areas are a possible source of cross infection and should be removed if infection control is to be maintained. Paper towels should be in an enclosed container in order to prevent contamination of clean towels. The position of registered manager should be filled as promptly as is possible. The organisation should look at the role and responsibilities of the registered manager in line with our expectations of this post. Key inspection report Care homes for older people Name: Address: Sunrise Operations Knowle Limited 1270 Warwick Road Knowle Solihull B93 9LQ     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: Lesley Beadsworth     Date: 1 8 0 9 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 31 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 31 Information about the care home Name of care home: Address: Sunrise Operations Knowle Limited 1270 Warwick Road Knowle Solihull B93 9LQ 01564732400 01564732401 knowle.alc@sunriseseniorliving.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sunrise Operations Knowle Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Age 50 and above The Maximum number that can be accommodated is 74. The registered person may provide the following category of service only Care Home with Nursing (Code N) To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories Older People (OP) 74 Date of last inspection Brief description of the care home Sunrise Operations refers to the care home complex as the Community and each unit as a Neighbourhood. Managers are referred to as coordinators and care staff as care managers. There is a marketing team who deal with accommodation, fees and contracts. Care Homes for Older People Page 4 of 31 Over 65 74 0 Brief description of the care home The Sunrise Assisted Living Neighbourhood at Knowle is located on the main Warwick Road from Knowle village to Solihull town centre. The service occupies one of two buildings in the Community and is called Lady Byron House There are communal toilets and assisted spa bathrooms, dining rooms, two activities room and communal sitting areas. All areas are furnished and decorated to a high standard. Two passenger lifts serve all floors. All bedroom spaces consist of suites of varying sizes and combination of rooms and have en suite facilities. They are suitably furnished although peoples own furniture can be used if wished. A call bell system has been fitted throughout the building. The surrounding gardens are landscaped and there is ample parking space. Fees vary according to the size of suite chosen and the level of care required. The Community should be contacted for up to date costs. Additional charges include a one off charge on admission of £5,000 for maintenance of all communal areas; hairdressing; chiropody; ironing; additional glasses to complimentary glass of wine with meals; external telephone line installation and call charges. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to Sunrise Operations Assisted Living Neighbourhood. As part of the inspection process the registered manager of the Neighbourhood was asked to complete and return an Annual Quality Assurance Assessment [AQAA], which is a self assessment and a dataset that is filled in once a year by all providers. However this was not requested in time for it to be returned for the purposes of this report. Surveys were given to residents. Four were completed and returned to us. Information contained within the surveys, from previous reports and any other information received about the Neighbourhood has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families, where possible, about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents Care Homes for Older People Page 6 of 31 care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit to this and the adjacent neighbourhood in the same Community took place over two days on 17th September from 09:15am to 5:15pm and 18th September from 09:30am to 09:00pm. A second inspector, Julie Preston, also took part in the visit. There was no registered manager of the Neighbourhood but the Executive Director of the Community was currently managing the Community. Care Homes for Older People Page 7 of 31 What the care home does well: Detailed and clear pre-admission assessments are carried out by senior staff to ensure that the needs of the people wishing to live at the Assisted Living Neighbourhood can be met. Care plans are in place for all people living at the Neighbourhood. These are detailed and inform staff of the care and support required. All health care needs are met with evidence of people having been seen by the GP, optician and chiropodist being seen in records seen. Residents are care for in a respectful manner and their privacy and dignity maintained. There is varied and stimulating activities available and that residents wishes and preferences are taken into account. A monthly activity meeting is held for residents to be involved. Visitors are made welcome and their needs considered. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives. There is a varied and interesting menu that includes themed days each month, for example there had been a Mexican day on the day before our visit. The menu has a four weekly cycle which each revised each season in order to be able to use seasonal foods. People spoken with said that they enjoyed the meals. Links are maintained with the local community with a Ladies Day held at the Neighbourhood to which people in the local community are invited. There have been other links with the neighbours choosing the names of the two buildings on site and local schoolchildren entering a competition to name the dogs that belong to the home. People know how to make a complaint and who to talk to if they had any concerns. A complaints log is maintained, which shows that complaints are addressed appropriately. The Assisted Living Neighbourhood provides a high standard of accommodation with attractive decor, furnishing and fittings throughout. Private accommodation is varied, consisting of different types and sizes of suites, all of which are larger than the required size and have en suite facilities. There is a private and attractive dining room where residents can entertain their family and friends and which can be hired free of charge. There is a charge for meals taken by them. They can also join the resident for meals in the main dining room. Appropriate equipment is provided to assist with specific needs, such as aids for visual impairment and discreet handrails to offer support for people with their mobility around the home. Care Homes for Older People Page 8 of 31 The Neighbourhood was clean and free of offensive odour in all areas visited. A resident commented in a survey that there was an exceptionally high standard of cleaning and room services. There are good infection control systems. There are sufficient staff to meet the needs of the people living in the Neighbourhood. Recruitment practice is robust and minimises the risk of the employment of unsuitable people. Sunrise induction training that is in line with Skills for Care is undertaken by all new staff. Monitoring and auditing of the service and practices takes place to ensure that all services operate in the best interests of residents. There was evidence that equipment is regularly serviced and maintained and that health and safety checks are carried out and all mandatory training related to health and safety is undertaken. All in house checks on the fire system were up to date. Fire training and fire drills were also up to date. Health and safety practice protects residents and staff at the home. 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 Care Homes for Older People Page 9 of 31 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 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed preadmission assessments are carried out to assess if the needs of prospective residents can be met. Evidence: All those that returned surveys said, Yes in the surveys returned to us to the question, Did you receive enough information to help you decide if this Community was the right place for you, before you moved in? The Statement of Purpose was not looked at on this occasion but we were told that there was a copy in each residents bedroom suite. Three care files were looked at as part of the case tracking process. Each had a preadmission assessment that had been carried out in order to assess if the Neighbourhood could meet the persons needs prior to offering them a place there. All the appropriate headings were included in the assessment and all medical conditions and needs were identified. There was sufficient clear detail to decide if the Care Homes for Older People Page 12 of 31 Evidence: Neighbourhood could meet the persons needs or not. One pre-admission assessment completed for a female person stated that she only wanted any personal care to be carried out by a female. On checking with a member of staff we found that this was happening. There is a marketing team attached to the Community who liaises with prospective residents and/or their representatives with regard to accommodation and fees. This team is not part of the management or care teams. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place that assist in residents needs being met. Residents have access to health care professionals and are cared for in a respectful manner. The medication process safeguards the residents well being with some minor shortfalls. Evidence: Three care files were looked at as part of the case tracking process. Each contained care plans that gave staff the instructions needed to meet the needs of that person and included details about their social needs. The organisations philosophy supported staff to be able to meet these needs. The care plans had not been reviewed at monthly intervals but those seen had been revised at each change of circumstance. Many of the current residents in this Neighbourhood were independent in their care needs. Records of falls, pressure areas, weight, bathing, nutrition and nutritional screening were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores [a break in the skin due to pressure, which reduces the blood supply to the area] and risk assessments for moving and Care Homes for Older People Page 14 of 31 Evidence: handling [transferring a person from one place to another] were also in place. These would help to minimise any risk in these areas. Individual risks were also assessed although one of the care files looked at belonged to a person who drove their own car, which was parked at the home. There was no evidence to support that any risk had been identified but risk assessments need to be carried out to confirm this and any necessary action taken to minimise any risk to the resident or the vehicle. We were told that there was only one person currently requiring nursing care in the Assisted Living Neighbourhood. This person, and others who were at risk of developing pressure sores, had preventative measures such as pressure relieving mattresses and cushions in use. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician and chiropodist being identified in the care files looked at. People are able to keep their own GP if the GP agrees but there is a designated GP who is willing to visit the home and people can register with if they wish. All residents who returned surveys to us by residents answered Always to the questions, Do you receive the care and support you need? and Does the home make sure that you get the medical care you need? The medication system was inspected. The pharmacist supplies most of the medicines in a monitored dosage system [MDS] where each medicine is dispensed in a blister pack from which to administer on a daily basis. Only Registered Nurses are responsible for the medication. The medication system was inspected. The pharmacist supplies most of the medicines in a monitored dosage system [MDS] where each medicine is dispensed in a blister pack from which to administer on a daily basis. Only Registered Nurses are responsible for the medication. Storage of medication was mainly in good order apart from some creams that were stored in the medication trolley with the oral medicines. Internal and external medicines must be stored separately. The majority of the liquid medicine, eye drops and creams or ointments had been dated when opened to ensure that they were destroyed within the timescales required to maintain their stability. However there were some that had not been dated. This would result in staff not knowing when to discard them. Care Homes for Older People Page 15 of 31 Evidence: The temperatures of the room where the medication is stored and of the medication fridge are monitored and recorded daily to ensure that the appropriate temperatures are maintained. The current medication is stored in the locked medication trolley which is kept in the locked designated room when not in use. A description of each medication in use and any side effects were kept with the Medication Administration Record Sheets [MARS], which would give staff the information they needed, to be aware of the reasons for the medication and what signs of side effects to look for. The MARS were looked at and where receipt of medication is also recorded. We found them to have no inappropriate gaps and codes were used to explain why when medication had not been given. A random audit of some of the medication in original packages showed that the remaining tablets corresponded with the calculated amount as per the MARS that should be remaining. This indicates that the correct medication was given at the correct time. Protocols were in place for as required medication. These ensured that staff know when and why the medication should be given. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct. Storage and records were appropriate. Risk assessments were in place for those people who self administer their medication and there is a locked space in each suite where medication can be kept secure. Observations and discussion with residents told us that people were cared for in a manner that maintained their privacy and dignity, with doors knocked before entering and staff waiting to be called in. The residents choice of gender of the person supporting their personal care is recorded and respected. Interaction between staff and residents was comfortable and respectful, with cheerful banter also being shared. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are occupied and stimulated. Visitors are made welcome and their needs considered. Residents have choices and control over their daily lives. Residents mainly enjoyed the nutritious and varied meals provided. Evidence: Answers in the surveys said that the home Always arranged activities that the residents can take part in if they wished. There was an active atmosphere in the home despite there being a great many suites that had not yet been filled. The Activity Calendar is different each week and is displayed in the reception area so that people know what activities are forthcoming. There are interesting events throughout each day from 10:30am until the movie night on most evenings that starts at 7pm. The other events included visiting entertainers, the 3pm Bistro Social, a trip to Hatton Craft Centre, Gentle Exercise facilitated by an external contractor, Armchair exercises, the Knitting Club, a relaxation group, a morning stroll, quizzes, the reading trolley, a classical music session in the Bistro, Scrabble Challenge and the Everyday Essentials mobile shop. Other occupations were seen to be happening in addition to the events calendar and included a resident accompanied by a member of staff to spend time on a computer in the well equipped and comfortable activity room and a Care Homes for Older People Page 17 of 31 Evidence: visit from the Sunbeam Alpine (classic cars) club, who brought their cars for residents to see. Champagne was being enjoyed in the Bistro. This was also a marketing event for possible prospective residents. Theme days take place each month and a Mexican Day had taken place the day before our visit. This involve Mexican costumes, decorations, entertainment and meals. Photos were available showing how much the residents seemed to be enjoying the day. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, and where and how to spend their time. There are several resident committees that enable people living there have a say in what happens in the home, including those for activities and dining. Some of the residents ahve also been involved in the landscaping of the gardens by choosing the plants and attending to the raised beds. Visiting is at any time. A visitor was spoken with during our visit who said that they were always made welcome and was seen to be able to talk comfortably with staff and management. A Bistro to the right of the entrance is open 24 hours a day for drinks and snacks, and is a comfortable, spacious cafe/bar that is suitably and aptly furnished. This is free of charge to residents and their visitors. A bread making machine has been recently acquired at the request of residents. The catering and catering staff are theresponsibility of the CAtering coordinator, who we met on the first day of our visit and who was helpful and knowledgable about catering and other areas of the service. Lunch was taken with the residents in the Assisted Living Neighbourhood. The dining room is an attractive and spacious, restaurant style area that is bright and welcoming. All tableware, cutlery and table linen were good quality and suitable for the people dining there. A variety of cold drinks are readily available and a complimentary glass of wine is offered at mealtimes. The three course meal was well presented and served in a professional manner. There were no people being assisted with their meals in the dining room whilst we were dining there. The meal was a choice of Oxtail soup or prawn salad followed by pan fried sea bass or vegetable lasagne with a medley of vegetables and croquette potatoes. There was a Care Homes for Older People Page 18 of 31 Evidence: dessert of baked rice pudding with sultanas. The menu told us that Banana Loaf would be offered at the 3pm social in the Bistro and that the evening meal comprised of Broccoli soup, braised sausage, creamed potatoes and mixed vegetables or assorted sandwiches. This was followed by a selection of desserts. The menu for the rest of the week was equally interesting and included a vegetarian choice at each mealtime. The menus are on a four weekly cycle and are rewritten each season to be able to use the seasonal fresh foods. In addition to the menu there are several alternatives that people can choose from and which are able to be ordered via the internal phone in their room. The alternatives consist of omelette, fish of the day, salad or sandwiches. The residents therefore have ample and varied choice of meals that are interesting and nutritious. People spoken with said that they enjoyed the food, although one person said it was not as good as it had been and only one person answered in the surveys that they Always liked the meals at the home; two people answered Usually and another, Sometimes. The latter also made the comment, Meals and related matters, in response to the question, What could the home do better?. Visitors are able to join their friend or relative for a meal in the main dining room but there is also a private dining room furnished and decorated to the same standard as the rest of the premises and that can be used by a resident and their family and friends, for example, for special occasions. There is no charge for the hire of the room but there is a charge for the meals. There is a dining committee that meets once a month to enable residents to air their views and be involved in the meals provided. The catering coordinator attends this meeting, which is chaired by a resident. This would be a useful opportunity to monitor any dissatisfaction with the meals. Community links are maintained with a Ladies Day which is open to the neighbourhood. Local schoolchildren entered a competition to name the three dogs belonging to the home and a prize was presented to the winners. The neighbourhood also chose the names Lady Byron and Queen Eleanor for the two buildings in the Community. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The The Community has appropriate training, policies and procedures to safeguard people from abuse. People can be confident that their concerns will be listened to and acted upon. Evidence: A copy of the complaints procedure was seen in the Statement of Purpose issued to each resident . However a copy of the procedure is not displayed in the reception to inform residents and visitors of how to make a complaint. People spoken with said that they knew who to talk to if they had any concerns. In the surveys returned to us all responses were Yes to the questions, Is there someone you can speak to informally if you are not happy? and Do you know how to make a formal complaint? A complaints log was maintained by the home and this showed that complaints had been appropriately addressed and managed. This gives people the confidence that their concerns will be listened to. The home has the appropriate safeguarding policies and procedures. Staff had attended training related to safeguarding in order to give them the knowledge and skills for them to be able to identify abuse and what to do if they suspect or witness it happening. Recruitment practices safeguard residents from the employment of unsuitable people. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Community offers the people living there attractive and comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. Evidence: The Assisted Living Neighbourhood is located in the Lady Byron building and has accommodation over 3 floors. The top floor is currently unoccupied. The reception area is impressive with a feature staircase adn a grand piano in the reception area. The Bistro is to the right of the entrance and is open 24 hours a day for drinks and snacks. All decor, furniture and fittings throughout the neighbourhood are good quality, stylish and are domestic in appearance. Communal areas are open plan yet homely with a spacious main lounge, a restaurant-style dining room, which are bright and attractive, and other smaller, comfortable sitting areas. Corridors are wide and enable wheelchair users and people needing assistance with their mobility to move around more easily. Hand rails are narrow discreet and narrow shelving that residents can use for support. Private accommodation consists of suites of varying designs and size. They range from two single bedrooms that share a communal kitchenette and bathroom to two room suites that can be used as two bedrooms or a sitting room and a bedroom and its own Care Homes for Older People Page 21 of 31 Evidence: kitchenette and bathroom. Call bells are provided in all rooms of the suite. Some of the vacant rooms had been staged as show room suites to help people choose the suite that they preferred. One suite had been set up as for someone with visual impairment and had appropriate equipment and furnishing including an innovative colour identification gadget that informed the user of the colours it was in contact with. This would enable a blind person to be aware of the colour of clothing they were putting together. As well as the ensuite facilities there are communal toilets close to the sitting and dining areas and two assisted spa baths that can be booked at no extra charge. All have high quality fitments. The hand washing facilities in communal areas included disposable towels and soap dispensers in order to maintain infection control. However the paper towels were open to contamination as they were in open topped wicker baskets. The Executive Director told us that closed dispensers had been ordered. Colourful fabric towels were also hanging in the bathrooms and although they were supposed to be for decoration purposes there is the risk of them being used by residents or visitors without the staff knowing and become a possible source of infection. A framed box containing items of nostalgia was outside each suite and are meant to be filled with items that are pertinent to the occupant of the suite. Some have been personalised but many are still as they were made by staff before Sunrise Knowle opened. They are decorative as well as when personalised being a useful way of residents identifying their room and acknowledging the interests or life of the resident. For example one person had included badges of organisations to which they had belonged in their earlier life and others contained photos of family or items relevant to their hobbies, armed service or work. Each floor has a large activity room; one furnished comfortably and the other fitted out especially for wet crafts such as painting. All areas visited were clean, well maintained and free of any offensive odour. In response to the question, What does the home do well, a resident made the comment, Exceptionally high standards of cleaning and room services. Dining room impeccable. Staff had ready access to protective clothing, disposable aprons and gloves, to use when supporting residents with personal care in order to prevent cross infection. There is a large, well equipped laundry on the top floor of the Lady Byron building that Care Homes for Older People Page 22 of 31 Evidence: launders bed linen, soiled linen and other communal items and has washing machines with the programmes suitable for dealing with these items. There is a smaller laundry on each floor for residents to use for personal clothing, or they can have their clothing collected each week. Whilst there are no additional fees for washing personal items there is an additional charge for ironing. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff available to meet the needs of the residents. Robust recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. Evidence: The rotas, discussions with staff, residents and visitors and observations made evidenced that there were sufficient staff in the Neighbourhood. In addition to care staff there are ancillary staff of housekeepers who are managed by the Maintenance Coordinator, catering staff that are managed by the Catering Manager and the activity team managed by the Activity Coordinator. There is also a consierge who works on the reception from 8am to 8pm. Staff rotas do not show the hours worked as a code is used for each shift, such as E for an early shift. The hours of the shift or a key to the codes used needs to be included on the rota. Only first names were used for the members of staff on the rota but it is considered good practice to also include the surname of each person. Staff were seen to interact well with residents and such positive comments as, You cant fault the staff, were made by people spoken with. Very caring carers. was a comment in one of the surveys in response to the question, What does the home do well?. Care Homes for Older People Page 24 of 31 Evidence: Three staff files were looked at to assess the recruitment procedure and practice of the organisation. Each of these contained the appropriate Protection of Vulnerable Adults [POVA] First checks and the Criminal Records Bureau [CRB] disclosures, a minimum of two written and two verbal references and evidence that there had been a formal recruitment process of application form, two interviews and that a contract had been issued. We were told that residents also assist with the recruitment of staff by attending the interviews and having a realistic input in the decision making. All evidence showed that the risk of the employment of unsuitable people had been minimised. All staff undertake the Sunrise Operations induction programme that is also in line with Skills for Care. This consists of nine days of theory training and a minimum of three days of practical supervision and gives them the information and skills that they need to be able to start the job effectively. Everyone who completed the surveys answered, Always or Usually to the questions, Are the staff available when you need them? and Do the staff listen to you and act on what you say? Care staff have undertaken the National Vocational Qualification Level 2 or 3 in Care. This qualification means that the person has undertaken relevant training and been assessed to be competent in their role. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a suitable person but who is not registered with us. Quality Assurance is in in place. Residents money is safeguarded. Health and safety practice safeguards residents and staff. Evidence: A person with the appropriate qualification and who has previous management experience manages the home. This is currently the executive director of the Knowle services whilst the organisation recruits a manager to be registered with us. She is not registered with us. The other management team members consist of the Maintenance Coordinator, responsible for maintenance and housekeeping staff, the catering coordinator responsible for the catering and catering staff and the activity and volunteer coordinator responsible for activities and the activity staff and for volunteers. Quality Assurance takes place, using the Sunrise QualityAssurance programme. Residents and families are able to feedback their opinions and views on the services Care Homes for Older People Page 26 of 31 Evidence: that are provided at family meetings, in an annual survey and in the various resident committees held each month. Monthly inspections take place by an objective representative of the Responsible Individual, which are audited and action plans formed from the outcomes. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Some money is held for safekeeping on behalf of residents when required although there was only one person who needed this service at the time of our visit. Records were seen and were in good order. There was evidence from a random check of records including those for hot water temperatures, the gas boiler, the hoists and the passenger lift, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system and fire drills were up to date. These are the responsibility of the maintenance coordinator who had a well organised system. Staff have undertaken mandatory training related to health and safety issues, such as Moving and Handling and Health and Safety. Health and safety practice protects residents and staff at the home. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 2 3 9 9 15 Internal and external medication should be stored separately. All ointments, creams and drops should be dated when opened so that they can be disposed of correctly. The home should monitor that the meals are consistently enjoyed by the people living there, and action as necessary. The complaints procedure should be displayed where residents and visitors are able to see it. Fabric towels should be removed from communal toilets and bathrooms. Disposable towels should be kept in appropriate enclosed containers in hand washing areas. The staff rotas should include the actual hours worked or a key to the code used. The surname of the employees should be included in the staff rota. The post of registered manager should be filled as promptly Page 29 of 31 4 5 6 7 8 9 16 26 26 27 27 31 Care Homes for Older People 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 as possible. Care Homes for Older People Page 30 of 31 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. 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