Care Home: Sunrise Operations of Sevenoaks Limited

What the care home does well The home has good processes in place for providing information to prospective residents, and for carrying out detailed assessments prior to admission. Care planning demonstrates the staff`s commitment to providing individualised and detailed personal care. A relative commented in a survey that " the service has approachable, professional and caring staff"; and a resident said that " the staff are very helpful and are always there when we need them". The home already has an excellent programme for activities and entertainment. This is a very friendly and welcoming home, and, as one resident said, "there is always something going on if you want to join in with it". The home provides good quality food in very attractive dining areas. Attention to detail means that special diets are catered for, and residents have a choice of food for each course of each meal. Residents are confident that their views and opinions are listened to and acted on, and that any concerns will be properly addressed. Opportunities for discussion and ongoing development of the home are included in regular residents` council meetings, and an activities committee. The home provides a monthly newsletter for residents and relatives. The building has been excellently designed to provide a comfortable and relaxed living environment. The decor, furniture and furnishings have been completed to a high standard. The manager is building up a dedicated and well trained staff team, who are sensitive to residents` needs. A staff member said that " the home looks after its residents and staff well; and the staff have regular support and supervision from the manager". There are good management processes in place, and support from the company via a wider area team. What has improved since the last inspection? This was the first key inspection for this home. What the care home could do better: Care plans which include wound care could be further improved. Wound care documentation includes good assessments for each dressing change, and regular photographs to demonstrate the healing progress. However, we viewed two care plans where two wounds for each resident were being assessed on one wound care chart. This means that it is not possible to follow the healing progress of individual wounds. Each wound should have separate documentation, so that the healing pathway for each wound can be clearly identified. The home has two clinical rooms which are both small in size. These are currently sufficient for storage and administration for the number of people in residence, but will need to be kept under review to ensure there is sufficient space when the home is fully occupied. The complaints procedure should contain clear details of the timescales for how complaints are responded to in the initial phases. Names and addresses of different people available to contact should be checked to ensure their accuracy. This includes CQC. Staff application forms request that applicants provide a history of employment for the previous ten years. This does not meet the regulations, (see Schedule 2, amended 2004), which state that applicants must be asked to provide a full employment history i.e. from the time of leaving full time education. We have not issued any requirements as a result of this inspection, as we are confident that these matters are already being addressed. Key inspection report Care homes for older people Name: Address: Sunrise Operations of Sevenoaks Limited Sunrise Of Sevenoaks 64 Westerham Road Sevenoaks Kent TN13 2PZ     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: Susan Hall     Date: 1 2 0 1 2 0 1 0 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 29 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 29 Information about the care home Name of care home: Address: Sunrise Operations of Sevenoaks Limited Sunrise Of Sevenoaks 64 Westerham Road Sevenoaks Kent TN13 2PZ . Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sunrise Operations of Sevenoaks Ltd Name of registered manager (if applicable) Ms Elaine Ferris Type of registration: Number of places registered: care home 96 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 96 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either whose primary needs on admission to the home are within the following categories Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Sunrise Senior Living are providers of nursing and care homes across the country, and opened this purpose built home in 2009. It is situated close to the main roads of the A25 and the A21, and to the M25 motorway. The town of Sevenoaks is close by, and Care Homes for Older People Page 4 of 29 Over 65 0 96 96 0 Brief description of the care home provides all of the usual town amenities. The home is set in its own landscaped gardens and is very attractively presented. There are car parking spaces at the front of the property. Accommodation is provided on three floors, ground, first and second, and there are two passenger lifts for easy access between floors. Sunrise call their homes communities and the different departments are neighbourhoods. The ground and first floors are for older people with residential and nursing needs, and this is known as the Assisted Living neighbourhood; and the second floor is for older people with dementia, who may also have nursing needs, and this is known as the Reminiscence Neighbourhood. The premises provide a well designed environment, and include single rooms with ensuite facilities, or one or two bedroom suites with en-suite facilities and kitchenettes. There are many communal areas for each neighbourhood, including a bistro bar where residents and guests can help themselves to snacks and drinks throughout the twentyfour hours. As this home includes residents with nursing needs there is always at least one nurse on duty twenty-four hours per day. Fees are discussed and arranged in accordance with individual needs and the room or suite chosen. Current fee levels range from £791.00 - £1358.00 per week (including accommodation, care and service). Care Homes for Older People Page 5 of 29 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 home is assessed as having a rating of Good, 2 stars This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. The AQAA was well completed by the manager, and was returned to the Commission within the required timescale. This was the first key inspection for this purpose built home, which was opened for business in October 2009. There are 96 beds, and the home had 44 residents on the Care Homes for Older People Page 6 of 29 day of the inspection. The manager has put a system in place to ensure that admissions are carried out in a controlled way, ensuring that there are more than the required number of staff who have completed induction training, and have been assessed for their competency, prior to more residents being admitted. We (i.e. CQC) sent out surveys prior to the inspection visit, and received nine completed forms from residents, relatives, staff and health professionals. These contained very positive comments. The inspection visit was carried out by one inspector starting at 09:15, and lasting for eight hours. The registered manager and the clinical lead were on duty throughout the day, and were very helpful with the process of the inspection. During the visit we talked with seven residents, a visitor, and twelve staff; and these included nurses, care co-ordinators, activities staff, maintenance, chef and housekeeping staff. We also viewed all areas of the home, and examined documentation such as residents guides, care plans, medication charts, complaints log, staff files and some maintenance records. The homes ethos is that it is a community of people living together in neighbourhoods, and the different units are referred to as neighbourhoods. These may be referred to as departments in this report, for ease of people who may not read the whole report. The home has accommodation for older people with residential or nursing needs on the ground and first floors, and this is known as the Assisted Living neighbourhood. Accommodation for residents with dementia (who may also have nursing needs) is on the second floor, and this is known as the Reminiscence Neighbourhood. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care plans which include wound care could be further improved. Wound care documentation includes good assessments for each dressing change, and regular photographs to demonstrate the healing progress. However, we viewed two care plans where two wounds for each resident were being assessed on one wound care chart. This means that it is not possible to follow the healing progress of individual wounds. Each wound should have separate documentation, so that the healing pathway for each wound can be clearly identified. The home has two clinical rooms which are both small in size. These are currently sufficient for storage and administration for the number of people in residence, but will need to be kept under review to ensure there is sufficient space when the home is fully Care Homes for Older People Page 8 of 29 occupied. The complaints procedure should contain clear details of the timescales for how complaints are responded to in the initial phases. Names and addresses of different people available to contact should be checked to ensure their accuracy. This includes CQC. Staff application forms request that applicants provide a history of employment for the previous ten years. This does not meet the regulations, (see Schedule 2, amended 2004), which state that applicants must be asked to provide a full employment history i.e. from the time of leaving full time education. We have not issued any requirements as a result of this inspection, as we are confident that these matters are already being addressed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 10 of 29 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. The home provides good information for enquirers and new residents. Each resident has a detailed pre-admission assessment prior to moving in. The home does not provide specific rehabilitation care, and so standard 6 is not applicable. Evidence: The statement of purpose and the residents guides are produced in separate bound folders. The statement of purpose gives an overview of the providers - Sunrise Senior Living - and provides information about the responsible individual for the home, and the registered manager. It includes the aims and objectives of the home, and the terms and conditions of residency; and there is a clear breakdown of how the fees are arranged. We were able to establish that most of the required information from Schedule 1 of the Care Homes Regulations is included, except for fire precautions and arrangements for associated emergency procedures. The manager stated that she would check that all the required information is included. Care Homes for Older People Page 11 of 29 Evidence: There are two residents guides, one for older people being admitted for Assisted Living (which includes residential and nursing care); and one for older people with dementia, which has some additional information for families and advocates. The guides are helpfully produced in large print, and contain day to day information about items such as using emergency call bells, arrangements for hairdressing and chiropody, activities available, and management of laundry, meals and meal times. The complaints procedure is included, and we noted that one of the addresses for contacts was incorrect. The manager said that this would be amended immediately. Residents (or their representatives) are encouraged to visit the home prior to making arrangements to move in. All residents have a pre-admission assessment, and these are usually carried out by two staff members; and always includes a registered nurse. We viewed four pre-admission assessments, and found them to be very comprehensive, and covering all aspects of peoples individual care and social needs. The manager meets with the resident and their family members or representatives as part of the admission process, and discusses the relevant details in regards to confidentiality of information, consent forms (e.g. for photographs), how privacy is maintained, and the terms and conditions of residency. All residents are provided with a contract, with each party retaining a copy. There is a trial period of thirty days, after which a review is carried out to decide whether or not to make the placement permanent. Care Homes for Older People Page 12 of 29 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. Residents personal and health needs are met by a good team of caring staff. Evidence: We viewed five care plans, including three for assisted living residents, and two for residents with dementia care. The care plan files are indexed for easy access of information, and include assessments and separate care plans for all aspects of daily living; such as personal care needs, moving and handling, skin integrity, nutrition, continence, communication, and social needs. Ongoing assessments are included for the risk of falls, moving and handling, nutrition and continence, and risks for specific areas e.g for using an electric wheelchair, using a recliner chair, or if there is a risk of wandering. Care plans are completed for all aspects of care, and all of the ones viewed were seen to be detailed and well written. They contain specific details such as likes to eat small meals, and prefers to sit at a table with others for company; and use hoist and two care staff for all moving and handling transfers. They also include details such as the name by which a person prefers to be called; their preferred times for getting up and going to bed; if they Care Homes for Older People Page 13 of 29 Evidence: prefer a bath or a shower; if they like the light left on at night or the door open; and if they prefer male or female care staff to attend to personal care. All care plans are reviewed monthly and updated as necessary. Suitable equipment, such as pressurerelieving mattresses and cushions, is provided by the company, and there are hospital beds for those who need them. Time charts are completed showing each staff interaction with residents, and including when the residents position has been altered, if they have been given food or drink, and if they have been assisted to the toilet. We viewed wound care documentation for two residents, and found this to be generally good, with a separate assessment of the wound at each dressing change. However, we noted that two wounds were being assessed on one assessment chart for both residents, and this means that it is not possible to identify if one wound is healing more quickly than the other. There must be separate documentation for each wound so that this can be clearly seen. The manager and the clinical lead said that they would ensure that this is done, and so a requirement has not been given. Wounds are photographed on a regular basis to help to demonstrate the progress of healing. Daily reports are written by the care staff who are delivering the care, and there is a separate report written by the nurses. Each resident has a designated carer, and they ensure that the resident has all their personal care needs met, and liaise with family members as required. The daily reports have good information, and include details such as the residents mood, if they have taken part in activities, the management of their personal care needs, and the persons food intake. Referrals are made to other health professionals as appropriate. Many of the residents register with a local GP practice, but others prefer to keep their previous GP. Arrangements can be made for physiotherapy at an extra cost, and the physiotherapists train the care staff to carry out exercises with individual residents, or instruct them in how to increase their mobility. The home has a strong emphasis on enabling residents to retain their independence and to do as much for themselves as they can. Referrals to other health professionals may include speech and language therapist, dietitian, dentist, and consultant psychiatrists or psychologists. One care plan viewed had very detailed information in regards to the persons oral health and contacting a dentist. Residents with dementia have additional pre-admission and admission assessments to assess the state of their mental health and their mental capacity. This includes their memory, their ability to make judgements, their concentration, and their ability to communicate their views and needs. Care Homes for Older People Page 14 of 29 Evidence: Medication is administered by registered nurses for all nursing clients, and this is stored in two clinical rooms, one on the ground floor, and one on the top floor. These both appear to be rather small for their purpose, but were seen to be adequate for the number of residents currently in the home. This will need to be kept under review. All of the medication for clients with dementia are also stored in the clinical room on the top floor. Non-nursing residents have their medication stored in individual locked cabinets in their own rooms, and this is administered by the care staff, or may be selfadministered. There are good assessment checks for residents who wish to manage their own medication, ensuring that they are physically and mentally able to cope with the processes involved. Clinical room temperatures and the drugs fridge temperature are checked and recorded daily. Most medication is administered using a monitored dosage system. We viewed the Medicine Administration Records (MAR charts) for the top floor, and these were seen to be well completed. All medicines are checked and receipted in by two nurses, and any hand written entries are checked and signed by two nurses. This is an example of good practice. There were no signature gaps seen on the MAR charts. The care plans indicate the staffs general understanding and application of the Mental Capacity Act in the relevant areas. There is a strong emphasis in the home on privacy and dignity, and we observed staff interacting well with residents. Staff do not wear uniforms, and this strengthens the homely and relaxed atmosphere on the premises. Residents surveys included the following comments: the home has excellent staff who are cheerful, friendly and helpful; and the home supports us, understands us, and listens to us; and there are excellent standards of care. The nursing staff, the designated carer, and senior staff, liaise with the resident, their family members and the GP in regards to end of life care, and try to adhere to residents specific wishes, such as if they prefer to stay in the home rather than go to hospital. The senior staff are also developing links with a local hospice, for additional advice and support if needed. Care Homes for Older People Page 15 of 29 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. The home provides an extensive range of activities, entertainment and outings, and enables residents to take a full part in choosing the programmes. Food is very well managed, with restaurant style dining rooms, well-prepared menus, and home cooked food. Evidence: The home has an excellent activities programme which is led by a dedicated activities organiser. The programme is displayed on a notice board in the reception area and in other strategic places (e.g. the lifts). There is a wide variety going on all day and evening from approximately 9.30 am, and includes items such as quizzes, word games, bingo, dominoes, afternoon socials, arts and crafts, cookery, flower-arranging and reminiscence. On the morning of the inspection visit several residents were taking part in a Wii competition for ten pin bowling, and we later heard the results being given out and the winner applauded. The home has different communal areas for activities, and one of the most popular is the bistro area on the ground floor. This is an area where residents and their guests can use the coffee and tea making facilities (there is a safe and easy to use coffee machine); and snacks are always available. It is a friendly area where the residents gather round tables, and chat or play games. The activities co-ordinator was currently reading through a book on The Royals in Care Homes for Older People Page 16 of 29 Evidence: the bistro area, reading a portion every day prior to lunch; and residents said that they look forward to this. There is also a large activities lounge which includes a wet area for activities such as cooking, or arts and crafts; other lounge areas, and a large dining room. The Reminiscence Neighbourhood on the top floor has its own bistro area, lounge, activities lounge and dining area. Residents were enjoying making scones in the bistro area on this floor, during the afternoon. Some activities and entertainments include residents from all areas of the home, such as tea-dances and some film shows. The reminiscence neighbourhood also has additional memory boxes, activity boards, and dressing-up clothes etc. for residents to enjoy at any time. There is a snoezelun room on this floor to aid residents to settle if they become agitated. The activities organiser arranges for entertainers to come into the home, such as a guest pianist, singers, and a harpist; and local schoolchildren at Christmas to sing carols. Activities and entertainments are held in different venues, providing more choice for residents. The activities team will increase as the numbers of residents increase; and care staff are also involved in taking part in activities so that they are a part of the whole life of the residents. This may also include one to one time for residents who are confined to their rooms, or who prefer to be on their own. The home has its own minibus, and a designated driver who is available for four days per week. He currently takes residents out for a minimum of four trips per week, as some of these may be half days or whole days. The residents are fully involved in making decisions about the activities they want, and where they wish to go for outings. This might include shopping in Sevenoaks, country drives, or days out by the sea when there is good weather. The home has its own hairdressing salon, and two self-employed hairdressers. They are building up friendships with the different residents, and visit the home on different days in the week. Residents are grateful that their spiritual needs can be met in the home, or that they can go out to church if they wish. A church service is currently held on Wednesdays for those who wish to attend, and Bible readings on Sundays. These services are currently for all residents, but as the numbers of residents increase, the Co-ordinator for residents with dementia said that she may try to arrange specific services for these residents in the future. The home provides an excellent dining experience, with attractive dining rooms, and Care Homes for Older People Page 17 of 29 Evidence: with tables laid with colour co-ordinated table settings. A menu is provided for each table, and residents sit wherever they want to. The residents choose their meals at the time of ordering, as in a restaurant. A full breakfast choice is available, including cooked breakfasts; and there is a three course menu for lunch and dinner, with a choice for each course. These include vegetarian and soft options; and the chef or cooks ensure that specific dietary needs can be met. Residents said that the food is very good, and that other choices are always available such as omelettes, soup, salads or jacket potatoes. A complimentary glass of wine is offered at lunch and dinner, and staff check with the GPs to ensure that wine is suitable for residents who would like it. Residents with dementia have their own dining area, and are shown show plates for each course of each meal, to enable them to choose what they want. The care staff eat their meals with the residents on this floor, so that it is a natural homely environment for the residents. The kitchens were seen to be clean and well organised. There is a notice board in the kitchen showing specific food preferences and any allergies for each resident. The home was recently visited by an Environmental Health Officer who awarded the kitchen four stars for cleanliness and food management. Care Homes for Older People Page 18 of 29 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. Residents are confident that they are listened to and that their views and concerns are of the utmost importance. Concerns and complaints are properly documented and investigated. Evidence: A copy of the complaints procedure is given to each resident or their representative on admission to the home; and this document is also included in the statement of purpose and the residents guides. All concerns and complaints are taken seriously and are appropriately investigated. There is good documentary evidence retained to confirm this. The procedure includes clear details of who to apply to in the event of a complaint, but does not clearly specify time scales for when complainants can expect a response, and this could be added in. It does state that where an investigation is needed, the complainant can expect this to be concluded and a response given to them within twenty-eight days. All residents have a delegated carer, and know that they can voice small everyday concerns to these staff who carry out their daily care. The clinical lead and the manager have a daily presence on each floor, and it is evident that residents know them well, and feel able to talk with them at anytime. This helps to deal with situations before they escalate into complaints. Care Homes for Older People Page 19 of 29 Evidence: All staff receive comprehensive training in regards to recognising and preventing different forms of abuse, and are aware of the whistle-blowing policy. This training is delivered as part of the induction programme, and the manager stated that there will be yearly updates. The manager and clinical lead showed a clear understanding of the importance of referring any suspicions of abuse to the Social Services Safeguarding Vulnerable Adults team. Care Homes for Older People Page 20 of 29 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 premises provide well designed facilities of a very high standard for residents enjoyment. This is a very comfortable, friendly and relaxed environment. Evidence: The premises are situated close to the main roads of the A25 and A21 as well as the M25 motorway, and are also close to the town of Sevenoaks. This a purpose built home which includes spacious landscaped gardens, and a well designed interior, with very attractive decor. The corridors are very wide and are therefore easy to negotiate with any equipment or for wheelchair use. There are two large passenger lifts providing access between floors. The home includes a wide range of communal areas on each floor, including lounges, activity lounges, bistro bar areas, dining rooms, and a private dining room for entertaining guests. All of the furniture and furnishings are of an excellent standard, and this is a very comfortable environment. Communal areas such as the bistro bars enable it to have a friendly and homely atmosphere. The gardens provide many seating and patio areas, and include two water features. There is a balcony on the second floor which enables residents to sit outside without having to go down to the gardens. The design incorporates sensible storage areas, including specific storage for hoists, Care Homes for Older People Page 21 of 29 Evidence: where they can be charged up. There is suitable equipment in place such as pressurerelieving mattresses, hospital beds, grab rails, and rails to lean on in the corridors. There are detailed fire alarm and fire risk precautions, and the local fire office officers are fully aware of the layout of the home, and have approved the fire risk assessment. The bedrooms are are of different sizes and shapes, promoting choice for residents. There are a number of suites or bedrooms for two people to share if they wish to do so; and bedrooms on the ground and first floors include facilities such as fridges. The suites also incorporate kitchenette areas. All bedrooms or suites have en-suite toilet facilities, and have showers or baths. There are additional spa bathrooms on each floor. All individual bedrooms and toilet areas have emergency pull cords; and there are pendant alarms available for residents for a small additional monthly fee, if they wish to use one of these as well. The home has two full time maintenance men, and servicing and maintenance records are kept up to date and are neatly maintained. We viewed a sample of these. Most of the services are contracted to specific service engineers to ensure they keep running smoothly. The home has domestic laundry facilities on two floors, where residents personal clothing is washed. Residents can assist with this process if they wish to do so. There is a main laundry facility on the ground floor with commercial washing machines and tumble dryers where all of the bed linen and table linen etc. is laundered. There is a housekeeper assigned to this each day. There is a team of housekeepers, led by a head housekeeper, who keep the building immaculately clean and tidy in all areas. The premises are beautifully designed and maintained. Care Homes for Older People Page 22 of 29 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. The home is developing a good team of well-trained and dedicated staff to provide all aspects of care for the residents. Evidence: The ground and first floors are for older people with residential or nursing needs (called assisted living in this home), and are led by a specific co-ordinator. The second floor, which is for older people with dementia (who may also have nursing needs) are overseen by a separate co-ordinator who is suitably trained in dementia care. All of the nursing care is overseen by the clinical lead who is a registered nurse. There is also at least one other nurse on duty throughout the twenty-four hours in addition to the clinical lead, and the number of nurses on duty for each shift will be increased in line with the number of nursing residents admitted to the building. Nursing staff have some supernumerary hours to ensure that they can keep up to date with documentation and ongoing training. The home is registered for 96 people. It was opened for business in October 2009, and had 44 residents at the time of the inspection. Care staff in Sunrise homes are known as care managers as they manage the individual care for the residents. The manager stated that they are employing approximately twenty per cent above the requirements of residents dependency levels, so as to ensure that there are staff properly inducted and familiar with their tasks before numbers of residents increase. Care Homes for Older People Page 23 of 29 Evidence: The manager has set a total increase of five residents per month (three for assisted living, and two with dementia), to ensure that staff can get to know residents well before additional residents are admitted. The company encourage care staff to study for NVQ training, and actively arrange this. There are currently seventeen care staff out of twenty-five who have completed NVQ levels 2 or 3; this is a good rate of 68 per cent. The home has good systems in place for recruitment checks and interviews. All applicants complete an application form and a health questionnaire, and an interview record is retained. The required checks are carried out, and include proof of identity, a recent photograph, Criminal Record Bureau (CRB) check, two written references, and confirmation of previous training. We viewed three recruitment files, and these were seen to be neatly filed, and to contain the relevant information. Nurses PIN numbers are checked with the Nursing and Midwifery Council (NMC). We noted that application forms incorrectly request applicants to provide an employment history for the past ten years; this should be a full employment history (i.e. from the time of leaving full time education), and with any gaps explored. We pointed this out to the manager and the Human Resources manager. They stated that this would be addressed immediately, and that they would inform senior staff in the company. We are confident that this is being done, and so a requirement has not been given. Interviews are carried out by the relevant head of department, as well as by the general manager. All staff go through a detailed induction process which includes the first day with the general manager, and a thirty day programme for all aspects of the life in the home. This process includes all mandatory training (e.g. health and safety, first aid and basic food hygiene); and all staff receive dementia care training. Staff are then required to carry out a number of shifts shadowing other staff, and have competency checks before they are allowed to work unsupervised. A training programme is in place to ensure that all mandatory training is completed and kept up to date. There will be yearly updates for subjects such as moving and handling and safeguarding vulnerable adults. Training is also being put into place for additional subjects such as the Mental Capacity Act, and end of life care, so that staff can further develop their skills and competencies. Care Homes for Older People Page 24 of 29 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 manager is suitably trained and experienced to lead the staff; and to ensure that the home is well run. Evidence: The registered manager is suitably qualified and experienced, and has worked for the company for a number of years. She has an open door policy, and has a daily presence in the home. Staff said that they find her to be approachable. There are regular meetings for all areas and departments in the home, and for heads of departments. Staff supervision and appraisals are delegated to the relevant heads of departments, and staff have quarterly one to one supervision. There is a performance based pay structure, and other incentives such as an Employee of the Month programme. There is a free counselling and and legal advice service for staff, and there are good staff facilities. There are excellent consultation processes set up for the residents. There are frequent Care Homes for Older People Page 25 of 29 Evidence: meetings to discuss and arrange activities, entertainment and outings; and separate meetings to discuss menus and suggested changes. There are also residents council meetings, and monthly family support meetings. Quality audits are carried out by the companys area support team; and monthly (regulation 26) visits are carried out by a senior representative. There will be ongoing surveys carried out to clarify residents views and their opinions of how the home is running. The registered manager ensures that all financial procedures are carried out appropriately, and she is assisted by a finances manager. Residents can have small amounts of pocket monies stored by the home. These individual accounts are maintained by the finances manager, and all credits and debits are recorded, and all receipts retained. These accounts are audited by a different company manager. Policies and procedures have been put into place and are named in the Annual Quality Assurance Assessment (AQAA). These are company policies and procedures, and the AQAA shows that some of these have not been reviewed in the last year. They must be checked to ensure that they are relevant to this particular home, and should be reviewed yearly. The manager stated in a message received after the inspection that this would be attended to. Records were generally seen to be well maintained, and up to date. The staff have good awareness of health and safety management. There are separate health and safety meetings to highlight any areas of concern and ensure that these are addressed. Accidents and incidents are recorded in detail, and there is a process in place to ensure that these are followed up over the next few days. Monthly audits highlight any patterns developing. Care Homes for Older People Page 26 of 29 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 27 of 29 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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