Care Home: Sunrise Operations Solihull

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What the care home does well Prospective residents are supplied with sufficient written details about the homes services as well as the fee rates. The services that are not included in the fee rate are clearly recorded. People are encouraged to visit the home and to mingle with other people and staff before making a decision about moving in. This provides ample time and opportunity for people to gather information and to form opinions about the home. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 6A senior member of staff and a trained nurse carries out a pre-admission assessment at a date and venue that is convenient to the prospective resident. This enables staff to determine the needs and whether the home can meet them. It also provides an opportunity to identify if any specialist equipment would be required and for questions to be asked about the home. This process provides people with re-assurance that their needs will be met at the time of admission. Observations of staff practices and review of a sample of care plans indicates that the services are flexible and care needs are personalised to suit the individual. Care plans are extensive; they provide carers with detailed guidance about the persons` needs and how they should be delivered taking into account personal preferences. People` healthcare needs are well met and staff have adopted a proactive approach to this aspect of care. This is achieved because there is a trained nurse either on the premises or on call at all times to deal with healthcare and any urgent events. Each service/department has its own dedicated manager who in turn is accountable to the home manager. There was a good audit trail of how the services are run and senior staff displayed enthusiasm for their roles. Medications are regularly audited to ensure that staff practices are consistent with people receiving their prescribed medications to promote their health and wellbeing. Staff recruitment practices appeared to be robust to ensure that people are protected from risks of abuse. All necessary checks are carried out before a position is confirmed. The staff training matrix suggested that staff are provided with the required training to carry out their roles effectively in meeting peoples needs. Staff receive regular formal supervisions to check that they possess the knowledge and skills to provide appropriate care for the current client group. The standard of the accommodation is spacious, with wide corridors and doorways for the access of wheelchair users. The standard of the furniture, fixtures and fittings is also very high. The type of accommodation varies from a bedroom to a suite consisting of lounge and bedroom. All suites include ensuite facilities consisting of wash hand basin, toilet and walk-in shower or bath. Health and safety arrangements were found to be good to prevent people who live in the home, visitors and staff from risks of accidents.A lot of emphasis is placed on the quality and choices of meals. Specialist diets are catered for. The dining room is very well appointed to promote a pleasing experience during mealtimes. All efforts are made to meet peoples individual tastes. In negotiation and agreement with the home people can take their pets with them into the home. Staff were observed assisting with the care a dog that belongs to a resident. The management structure of the premises and services indicated a firm management team who interact well with each other to promote a well run establishment. People living in the home and staff provided positive comments about senior staff and the support and guidance they receive. There is an established quality assurance system in place that takes into account the opinions of people who live in the home, external professionals and regular audits of all aspects of the services. This indicates that staff are constantly striving in making ongoing improvements for the benefit of the people who use the services. There are a number of various activities held within the home every day and regular outings are provided using the homes own mini bus. The majority of comments made by people were positive; "I like it here, staff are good and work very hard, I go to bed when I feel like it, staff are excellent from top to bottom, when I ask staff to do something they do it very willingly". What has improved since the last inspection? What the care home could do better: Staffing levels during daytime hours were found to be inadequate. Staff were observed struggling to meet peoples` needs in a timely fashion. A review of staffing levels is required that takes into account the numbers of people and their dependency levels and the expectations of clientele, the extensive layout of the premises, staff tasks in addition to provision of personal care, the housekeeping hours and their actual roles. These reviews need to be regularly repeated as the occupancy increases Ongoing reviews need to be carried out in respect of the designated staff hours for activities. Currently staff cover both registrations; those people who require one to one sessions were not receiving them. CARE HOMES FOR OLDER PEOPLE Sunrise Operations Solihull 1 Worcester Way Solihull West Midlands B90 4JX Lead Inspector Kath Strong Unannounced Inspection 20th March 2008 09:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunrise Operations Solihull Address 1 Worcester Way Solihull West Midlands B90 4JX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 733 4960 0121 733 4961 Sunrise Operations Solihull Limited Honor Keatley Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61) of places Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered person may provide personal care (without nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - OP 61 The maximum number of service users to be accommodated is 61 2. Date of last inspection First Key Inspection Brief Description of the Service: Sunrise is part of the Sunrise Community that commenced operating in the USA during 1981 and has subsequently expanded both in the USA and Europe. The first Sunrise Community opened in South East London in 1998. This branch of Sunrise opened in March 2007 and is a registered care home (without nursing) for assisted living for sixty-one older people. The building is purpose built; it offers an exceptionally high standard of spacious accommodation. The ground and first floors consist of the registered premises for this inspection. A separate registration is in place for the people who occupy the second floor of the premises. The front reception desk is open from 8am until 8pm seven days a week to receive telephone calls, enquiries, completion of some administration tasks and to direct people visiting the building. The home is located on the outskirts of a residential area, a short distance from Stratford road within the suburb of Shirley. It is situated close to motorway links. Transport would need to be arranged for people to access local amenities. There is off road parking situated to the front of the premises. The service user guide provides details of the four types of accommodation charges. Fee rates of services that are not included in the accommodation charges are well specified. They include guest meals, ironing, escort duties, care management for a spa bath, pendant call service, ‘wanderguard’, television rental, telephone line rental, newspapers and magazines, chiropody, continence care, hairdressing, ophthalmic and dental services, medication administration including ordering and collection, postage, alcoholic beverages, activities and outings. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home did not know that the fieldwork visit would be carried out; this is to enable the inspector to obtain an accurate view of the standards of the services provided. On the day of the visit, the home had 24 people living there. Assistance with the inspection process was provided by the manager. At the conclusion feedback was given to the manager. No Immediate Requirements were made. Information was gathered from speaking with people who reside at the home, a relative and staff. Care, health and safety and the arrangements for medications were inspected. Staff personnel files were checked and staff were observed whilst performing their duties. A partial tour of the premises was carried out. Two of the three care plans reviewed were case tracked. This involves obtaining information about individuals’ experiences of living at the home. This is done by meeting with or observing people, discussing their care needs with staff, looking at care plans and focussing on outcomes. Tracking peoples care needs and how the care is delivered helps us to understand the experiences of those people and the standards of care provision. Prior to the visit the home had completed the annual quality assurance assessment and returned it to us. The information within the document advised of what the home does well, improvements made during the last 12 months and what the home would like to further improve. This provided details that contribute to the inspection process and highlights areas that may be explored during the fieldwork visit. The focus of inspections undertaken by us is based upon the outcomes for people who live in the home and their views about the services provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and aspects of service provision that need further development. The quality rating for this service is two stars. This means that the people who use this service experience good quality outcomes. What the service does well: Prospective residents are supplied with sufficient written details about the homes services as well as the fee rates. The services that are not included in the fee rate are clearly recorded. People are encouraged to visit the home and to mingle with other people and staff before making a decision about moving in. This provides ample time and opportunity for people to gather information and to form opinions about the home. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 6 A senior member of staff and a trained nurse carries out a pre-admission assessment at a date and venue that is convenient to the prospective resident. This enables staff to determine the needs and whether the home can meet them. It also provides an opportunity to identify if any specialist equipment would be required and for questions to be asked about the home. This process provides people with re-assurance that their needs will be met at the time of admission. Observations of staff practices and review of a sample of care plans indicates that the services are flexible and care needs are personalised to suit the individual. Care plans are extensive; they provide carers with detailed guidance about the persons’ needs and how they should be delivered taking into account personal preferences. People’ healthcare needs are well met and staff have adopted a proactive approach to this aspect of care. This is achieved because there is a trained nurse either on the premises or on call at all times to deal with healthcare and any urgent events. Each service/department has its own dedicated manager who in turn is accountable to the home manager. There was a good audit trail of how the services are run and senior staff displayed enthusiasm for their roles. Medications are regularly audited to ensure that staff practices are consistent with people receiving their prescribed medications to promote their health and wellbeing. Staff recruitment practices appeared to be robust to ensure that people are protected from risks of abuse. All necessary checks are carried out before a position is confirmed. The staff training matrix suggested that staff are provided with the required training to carry out their roles effectively in meeting peoples needs. Staff receive regular formal supervisions to check that they possess the knowledge and skills to provide appropriate care for the current client group. The standard of the accommodation is spacious, with wide corridors and doorways for the access of wheelchair users. The standard of the furniture, fixtures and fittings is also very high. The type of accommodation varies from a bedroom to a suite consisting of lounge and bedroom. All suites include ensuite facilities consisting of wash hand basin, toilet and walk-in shower or bath. Health and safety arrangements were found to be good to prevent people who live in the home, visitors and staff from risks of accidents. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 7 A lot of emphasis is placed on the quality and choices of meals. Specialist diets are catered for. The dining room is very well appointed to promote a pleasing experience during mealtimes. All efforts are made to meet peoples individual tastes. In negotiation and agreement with the home people can take their pets with them into the home. Staff were observed assisting with the care a dog that belongs to a resident. The management structure of the premises and services indicated a firm management team who interact well with each other to promote a well run establishment. People living in the home and staff provided positive comments about senior staff and the support and guidance they receive. There is an established quality assurance system in place that takes into account the opinions of people who live in the home, external professionals and regular audits of all aspects of the services. This indicates that staff are constantly striving in making ongoing improvements for the benefit of the people who use the services. There are a number of various activities held within the home every day and regular outings are provided using the homes own mini bus. The majority of comments made by people were positive; “I like it here, staff are good and work very hard, I go to bed when I feel like it, staff are excellent from top to bottom, when I ask staff to do something they do it very willingly”. What has improved since the last inspection? What they could do better: Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 8 Staffing levels during daytime hours were found to be inadequate. Staff were observed struggling to meet peoples’ needs in a timely fashion. A review of staffing levels is required that takes into account the numbers of people and their dependency levels and the expectations of clientele, the extensive layout of the premises, staff tasks in addition to provision of personal care, the housekeeping hours and their actual roles. These reviews need to be regularly repeated as the occupancy increases Ongoing reviews need to be carried out in respect of the designated staff hours for activities. Currently staff cover both registrations; those people who require one to one sessions were not receiving them. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supplied with adequate written details to enable them to make a decision about living in the home. A senior member of staff carries out a preadmission assessment to determine that the home is able to meet the individuals’ needs. EVIDENCE: The statement of purpose was reviewed. An error in respect of the numbers of communal bathrooms was brought to the managers attention who advised that this would be addressed soon as the document was currently being reviewed. Otherwise the content was such to reflect the registration of the home and the services provided. The document is available in large print, alternative languages and audiocassette for the benefit of ethnic minorities and those people who are visually impaired. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 11 The service user guide was found to be extensive; it included the varying fee rates and details of the services where extra charges would be required. A copy of this is given to anyone who displays an interest in the home. A blank copy of the ‘Resident Agreement’ suggests that all required aspects are covered. This enables people who are living in the home to be aware of their rights. A pre-admission assessment is carried out by a senior member of staff and a registered nurse on a date and at a venue that is suitable to the prospective resident. The three files examined contained the respective assessments. They were seen to be comprehensive and included such topics as eating habits, sleep pattern and preferred activities. This is used as the tool for later more in depth assessments and development of care plans that suits the person’s needs and lifestyle. A letter is supplied confirming that the home is able to meet the persons assessed needs. The manager confirmed that where it was determined that the home would not be able to meet the individuals’ needs that a placement would not be offered. Also if further assessments were needed of a current occupant because the home was struggling to continue to meet the persons needs then alternative accommodation would be recommended. People enable review should can make as many pre-admission visits to the home as they like to them to make a decision about the home. Following admission a is carried out after 30 days for both sides to confirm that the placement be made permanent. The home provides respite care but not intermediate care. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with detailed guidance about an individuals needs and how they should be met. Healthcare needs are identified and external professionals assess and prescribe the necessary treatment to promote peoples wellbeing. EVIDENCE: Each person has a written care plan. This is an individual plan about what the person is able to do independently and states what assistance is required from staff for the person to maintain their wellbeing. Care plans include risk assessments about the individuals’ activities within the home and the community. These identify the risks and a description of what action is needed to minimise those risks. Care plans should be reviewed regularly to ensure that they are up to date and pertinent to the persons needs. The home has chosen to refer to care plans as ISP’s (individual service plans). Of the three ISP’s reviewed they without exception, provided very detailed Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 13 information. Upon admission staff complete a ‘move in checklist’ list to confirm that people have been orientated to the different aspects and departments of the home. This is viewed as being good practice and assists people in getting to know the layout of the home and the people within it. The files contained separate sections for such things as emergency information, doctors input, medication and allergies, a medical log, health consultations, diet and nutrition, hobbies and activities, communication, mobilising, sleeping, spiritual needs and behaviour and more. The recordings were comprehensive and included various relevant health and risk assessments. The guidance of personal care needs were very detailed and easy for carers to follow. There was lots of evidence that when compiling the personal care reports that peoples personal preferences had been incorporated. Although the home is not registered for nursing care the organisation employs trained nurses, one of whom is available at all times. They participate with the pre-admission assessments, assessing and documenting healthcare needs and organising the input of external healthcare professionals when a need has been identified. Trained nurses provide an integral part of the services to promote peoples health and they take a proactive approach to identifying and meeting health needs. The files contained risk assessments that were relevant to the persons activities such as use of strident, outings and mini bus usage, slips or trips, use of liquid soap, mobilising and falls. Care plans were being regularly reviewed. They had been signed by people who had participated during the collation or formal reviews to confirm their agreement of it. Signatures included the person who had moved in, relatives or their representatives and staff. Any care and daily recordings were made by carers in a file that was housed in the individuals’ own bedroom. All personal care that had been delivered had been recorded. People who live in the home said, “When I ask staff to do something they do it willingly, S.…. and .… are the two gentlemen here and they are great”. A relative commented, “I don’t have any worries any more, Mum hurt herself twice they rang to let me know immediately”. The management of medications were checked. The written policy was noted to be extensive and provides staff with full guidance. Each suite has its own locked cabinet within a cupboard, which is used for the storage if the persons own medications. Some people who have been assessed as being capable administer their own medications. These, along with all others are regularly Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 14 audited by trained nurses to ensure that staff practices are safe and that people had received their prescribed medications appropriately. The MAR (medication administration record) charts were accompanied by a photograph and details about of special instructions. The recordings made by staff appeared to be satisfactory. When the home receives new medications dispensed by the pharmacist two staff check them and record their findings on the MAR chart. The medications of those people whose ISP’s had been seen, were audited. There was an identified need for the medications of a person who had recently been discharged from hospital to be audited to clarify the numbers of tablets held by the home and those dispensed by the hospital. Staff were observed using the preferred term of address towards people. Personal care was delivered in the privacy of the persons’ own suite or a communal bathroom to preserve their dignity. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The varied activities programme may be restrictive to some people due to lack of staff availability. A wholesome and varied diet is offered and specialist dietary needs are catered for. EVIDENCE: The activities programme was on display in the reception area. The information board also included details about legal surgeries, the next family meeting date, a volunteer advertisement and details concerning a show in Birmingham. The daily programme of activities was varied to be attractive to a wide range of preferences. The programme offered massage, quizzes, card games, bingo, dominoes, current affairs, walks, exercise, scrabble and other board games and competitive board games with a senior member of staff. Televised national sports such as championship golf, cricket or rugby were also advertised. Evening entertainment was a regular event and external entertainers are invited to the home. During the fieldwork visit people were offered a facial massage and manicure. The homes own mini bus is used on a regular basis to offer people shopping trips and outings to places such as Warwick or Stratford. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 16 Records are well maintained of peoples’ participation or refusals. These will provide the activities team with useful information when carrying out reviews of the activities programme. The organisation employs a full time person who organises the programme and time permitting also participates plays an active role. He is assisted by two other staff who each work ten hours per week. The roles of these employees covers both registered services. It was evident that they did not have time to carry out one to one sessions with people. There would be a high demand for one to one input with people within the other unit. Also during any afternoon outings a carer would be expected to accompany them to ensure peoples safety whilst out of the home thus depleting staffing levels of carers. Regular reviews of the staffing levels need to be carried out to ensure that there are sufficient to meet peoples’ expectations and aspirations. Regular meetings are held with people who live in the home and families to discuss and propose changes where it may enhance the quality of their lifestyles. A brief meeting was held with the manager of the kitchen/dining services. He confirmed that specialist diets were being catered for. A copy of the menu was supplied and information provided that further choices are provided that don’t appear on the menu. This was evidenced on the display board at the entrance to the dining room. The main menu advised that people can have a number of courses and cooked meals during all three meals. Adjacent to the board a dining table was arranged and included plated samples of the two main courses being offered for lunch. This initiative permits people to view the meals to assist them in making a choice about what they would like to eat. This initiative is very innovative and helpful to people who have limited memories. The dining room provides a buffet of cold breakfast foods for anyone who chooses to rise quite late. During mealtimes carers take on the role of taking orders and serving meals, clearing away and relaying the tables. Lunch was observed being served. The standard of the meal appeared to be very high and carers served meals in a very courteous and discreet manner. The ground floor includes a bistro that consists of a bar, behind which refreshments can be prepared by people who live in the home and their visitors. Freshly made cakes are also made available each afternoon for people to help themselves. The manager holds regular meetings with people who live in the home, the minutes indicate that changes are made when requests are put forward and the menu is also regularly reviewed. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ opinions are listened to and they are encouraged to raise concerns, which would be dealt with effectively. The procedures and staff practices suggest that people living in the home are protected from risks of abuse. EVIDENCE: A copy of the complaints procedure is located in all personal suites and is accompanied by a copy of the confidentiality policy and the procedure for access to records. Since opening of the home one year ago four complaints had been logged. None were of a serious nature and the records suggested that they had been dealt with appropriately and in a timely fashion. We have not received any complaints about the organisation. The written adult protection policy was reviewed. Although adequate the content provides the barest of information for staff guidance. For instance, it does not advise of the differing types of abuse or when abuse is suspected what actions staff need to take. It should also instruct staff that we need to be informed where concerns are identified. The document is recommended be improved by expanding it. Most staff have received training in this aspect of care and the manager advised that further training dates have been arranged to capture the remaining staff. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with warm, comfortable, well maintained and safe and exceptionally high standard of accommodation. EVIDENCE: The home is purpose built to an exceptionally high specification. The décor, furniture, fixtures and fittings are of a very high standard. The communal areas on the ground floor consist of a large spacious reception where a receptionist is on duty from 8am until 8pm seven days per week. To the left of reception there is a bistro, which is open 24 hours a day for people to help themselves to refreshments and snacks. There is also a conservatory off which overlooks the front aspect of the building. To the right of the reception a large airy lounge is situated it includes a wide screen television and a grand piano. The kitchen is situated off from the main very well appointed dining room. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 19 The first floor houses another good sized lounge and it is set up for various activities. This room also provides facilities for people to make themselves refreshments. All areas of the home have an abundance of tasteful pictures, ornaments and soft furnishings. The wide corridors offer more comfortable seating where people can sit quietly or have confidential talks with their visitors. Doorways are adequate to accommodate people who are wheelchair users. Each floor houses two spa bathrooms where people can relax either independently or with the assistance of a member of staff. Communal toilets are strategically situated throughout the home for ease of access. There are four types of private suites for people to choose from and whilst the home is only partially full newly admitted people can also choose between a walk in en-site shower or bath. All suites are tastefully furnished and include a fridge to enable people to store cold foods and drinks. A bedroom door key is offered to occupants that can be easily overridden by staff in the event of an emergency. This facility promotes peoples independence and privacy. There was evidence that people have taken their own furniture into their suites to make them feel homely. The standard of lighting is in keeping with the rest of the building. All areas of the premises were noted to be very hygienic. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortage of staff during daytime hours means that people are not receiving their personal care needs in a timely fashion. Staff recruitment practices are robust; this protects people living in the home from risks of abuse. The organisation provides staff training to enable them to carry out their roles effectively. EVIDENCE: The staff rota was checked and it was noted that there were inadequate staffing levels during daytime hours. There would be four staff rostered each morning but their duties include serving breakfast, medications, laundry, ironing, cleaning and tidying. These duties are additional to assisting people to rise and retire, complete their personal hygiene and care needs and to dress/undress. It should also be noted two of the people living in the home require the assistance of two carers for all personal care. From 11:00 the numbers of carers decrease to three for the remainder of the day. When an afternoon outing takes place a carer is required to accompany people. During these periods two carers have to cope with the needs of the remaining people including the two who require two carers to assist them. Information was given that when carers require help that they should call on a senior member of staff, this system was noted to result in delays. During the afternoon when two carers were on the premises observation of staff practices was carried out. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 21 A delay was noted when a carer was requesting assistance from a manager to take someone to the toilet, by which time the individual was quite distressed. This was not a satisfactory experience for the person. During staff interviews they said that up to three people would request assistance in retiring at the same time, staff are unable to cope during those times. Comments received from people residing in the home included “Difficult to get the buzzer answered because there aren’t enough staff, staff are excellent, staff are good and work very hard, I might have to wait for staff”. The organisation must ensure that sufficient staff are available at all times to meet peoples needs. A review of the required staffing levels needs to be carried out taking into account, the numbers and dependency levels of people living in the home, the expectations of the clientele, the tasks that staff have to carry out that are additional to providing personal care, the size and layout of the building. The review needs to include the allocated hours for housekeeping staff and their actual roles. Upon completion a copy of the review should be forwarded to us and where shortfalls are identified these need to be rectified. The review should form part of the organisations ongoing process whilst the occupancy is gradually increasing. The manager advised that she was building up a team of bank staff to fill gaps when permanent staff are unable to work and that agency staff have not been utilised since February. This is viewed as being goods practice because it ensures continuity of care. Three staff files were checked including the latest recruit. All relevant checks were being carried out and two written satisfactory references were being obtained before a position was confirmed. New staff complete the homes own induction, which includes mandatory training. They also undergo a period of shadowing until they are assessed as being competent to work independently. A more in depth induction pack is completed by the individual that mirrors the contents of ‘Skills for Care’ to provide them with the basic skills to work in the care sector. Of the carers currently employed 88 have successfully completed NVQ level 2 or equivalent. Staff are required to undertake training in moving and handling, protection of vulnerable adults, challenging behaviour, fire safety, dementia care, food hygiene, basic first aid, medication, dining, activities and housekeeping and the respective refresher courses. Some gaps in staff training were identified but dates for them to complete the training had been arranged. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and is constantly striving to make ongoing improvements for the benefit of those people who live in the home. Arrangements in respect of health and safety are robust and serve to protect people from risks of injuries. EVIDENCE: The manager has not been registered with us but appears to possess the knowledge and skills to carry out her duties efficiently and to delegate tasks to staff. A relaxed and friendly atmosphere was evident and staff were working well as a team. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 23 There was an established quality assurance system, which had been completed during 2007 and a report produced early 2008 with a result of 87 . Any shortfalls identified include an action plan for rectifying the deficit. The audits carried out include resident’s views, medications, maintenance, incident reporting, safety, infection control, food safety, the premises, equipment, peoples care, documentation, staff training, communications and procedures. Regulation 26 visits and reports were being produced. The arrangements for the safekeeping and transactions of peoples’ personal monies were robust; this prevents financial abuse. Regular staff meetings were being held to promote the effective running of the home. Staff formal supervisory meetings were also being held to ensure that they continue to possess the knowledge and skills to perform appropriately within the roles. The accident records are good and where necessary we had been informed of events that may have affected the wellbeing of people living in the home. All relevant checks and servicing of equipment had been carried out to ensure that they continued to be fit for purpose. The fire alarms and emergency lighting systems were being regularly checked and the results recorded to protect people from harm in the event of an emergency situation. Fire drills were also being carried out. The arrangements appear to protect people living in the home and others from the risk of injury. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? First key inspection STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(2)(m) Requirement The home must carry out a review of staff availability to meet the recreational expectations of the people living in the home, to include those requiring one to one sessions. A programme to repeat the reviews as the occupancy levels increase needs to be established. This is required to promote peoples quality of life. A review of staffing levels must be carried out as a matter of urgency. It must take into account the numbers and dependency levels of people, the expectations of the clientele, carers tasks that are in addition to provision of personal care, the size and layout of the building, the hours allocated to housekeeping staff and their actual roles. Where deficits are identified these must be rectified. This process must be repeated as occupancy levels increase. Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 26 Timescale for action 30/06/08 2. OP27 18(1) 31/05/08 Upon completion, a copy of the report must be forwarded to us for consideration. This is required to ensure that people receive the quality of care they are entitled to. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations An audit of medications is recommended when people return from hospital to clarify the numbers of medications already held by the home and those dispensed by the hospital. It is recommended that the written policy in respect of adult protection be expanded as detailed in the body of the report, to ensure that staff are provided with comprehensive guidance. 2. OP18 Sunrise Operations Solihull DS0000069303.V360924.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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