Care Home: Sycamore Care Centre

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What the care home does well The friendly interaction of service users and staff creates a warm and welcoming atmosphere in the home. Good information is gathered about the needs of anyone wishing to move into the home or wishing to use any of the services within it. This means that the home can make an informed decision as to whether they can meet their needs effectively. Anyone interested in using the services are encouraged to visit the home and look around so that they can make an informed choice about moving in and using the service. When a decision has been made that this is the right place for the person to receive a service, the arrival date is well organized. Staff are identified to "meet and greet" the person and help them to become familiar with their new surroundings. This helps the person to feel welcome and safe. Care plans are put in place and these record details of the person`s assessed needs. Clear guidelines lead staff to support the person in the way that they prefer and the way best practice dictates. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Staff approach service users sensitively and support them with personal tasks discreetly. This makes service users feel confident, one said, "The staff are really good they are very gentle and help me in a way that make me feel good." A good range of fresh food is available that is cooked well and served attractively. If service users have a special dietary need then this is addressed, for example, some people may need their food to be cut up for them or liquidised. Service users said:"The food is always good." "I like the food there is always enough to eat." Service users` independence is promoted and they are supported to live a lifestyle that is based on their personal preferences. A variety of activities are arranged by people especially employed and who have interest and skills in this area. Activities are arranged in and around the home and service users are supported to visit local places of interests. Furthermore people are encouraged to maintain their interests and hobbies and go out independently if they are able. Visitors to the home are encouraged and service user comments include:"Our boys visit us regularly and they are made to feel very welcome." "My family are always made to feel welcome and staff keep them up to date with how I am doing." An enthusiastic staff team support service users to meet their individual needs and to develop and maintain their independence. So that staff develop the skills and knowledge needed, a good training programme is in place. The service is run by a clear management team who are each designated to lead staff teams that are responsible for the care provided throughout the home. Furthermore good systems are in place that monitor the quality of care delivered to ensure that it is in the service users` best interests. What has improved since the last inspection? Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 The Statement of Purpose and Service User Guide have been reviewed and updated to reflect the changes and developments in the service. The range of fees charged is included in the Service User Guide and the full amount of fees charged by the home to individuals is included in their contracts. The way that the fees are broken down now makes it clear who is responsible for paying them and for what amount the service user is responsible. Care plans have been reviewed and developed and now demonstrate clearly how individuals` needs are supported and met and furthermore plans to minimise assessed risks are included. Such plans are monitored monthly and reviewed annually when the service user, their family and the care manager are invited. Three activity organisers have been employed to develop and organise activities throughout the home. Service users now experience an active lifestyle and activity programmes are placed in visible positions around the home to inform people of what is going on. The environment is now more stimulating and easier to access for people who may experience dementia type illnesses. Pictures and objects that may promote reminiscence or activity that individuals` particularly enjoyed in their past are tastefully and thoughtfully placed around the home. Pictorial signs to the bathrooms, toilets and dining areas help people to orientate themselves. Most staff have attended training regarding the local authority`s safeguarding adults procedures and plans are in place for those who have not. This means that staff know what action to take if they witness abusive practice or have an incident of abuse reported to them. Since the home has been extended the numbers of staff needed to meet service users` needs has been reviewed to ensure that the resources needed are available throughout the home. Staff now are only employed following full CRB (Criminal Records Bureau) clearance and this ensures that they are "fit" to carry out their role as carers. So that the registered manager is always available to carry out her role effectively, she is not included in the number of staff needed to address service users` needs. This means that she is available to oversee and monitor the running of the service and to supervise staff. What the care home could do better: A detailed record of complaints and concerns must be kept with the action taken to address them, so that service users and their families are confident that the home takes their seriously,Sycamore Care CentreDS0000015741.V376623.R02.S.doc Version 5.2 Any incident in the home that may affect a service user, including a serious accident, must be reported to the CQC (Care Quality Commission). So that only fully trained people support service users directly and unsupervised, the policies and procedures in place regarding the responsibilities of trainees, should always be followed. Key inspection report CARE HOMES FOR OLDER PEOPLE Sycamore Care Centre Nookside Grindon Sunderland SR4 8PQ Lead Inspector Elsie Allnutt Key Unannounced Inspection 20th July 2009 09:00 DS0000015741.V376623.R02.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 2 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 Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Care Centre Address Nookside Grindon Sunderland SR4 8PQ 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) 0191 525 0181 0191 528 8908 care@sycamorelodge.co.uk SLW Limited Judith Dolan Care Home 99 Category(ies) of Dementia (99), Old age, not falling within any registration, with number other category (99), Physical disability (99) of places Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only Care Home with Nursing - Code N To service users of the following gender - Either Whose Primary care needs on admission to the home are within the following categories: Old age not faling within any other category Code OP, maximum number of places 99 Dementia Code DE, maximum number of places 99 2. Physical disability Code PD, maximum number of places 99 The maximum number of users who can be accommodated is 99 Date of last inspection 8th August 2007 Brief Description of the Service: The buildings to this service stand in their own grounds with well-established trees and is approached by a private drive. Although it is located in the heart of the Grindon community it has a feel of being in the country due to its location and large expanse of external space. The current owner has owned the home for many years. Soon after buying the property the owner built an extension to the home, a two-storey building, in order to enable forty people to be accommodated. Although the home continues to provide residential care to 40 older people, over the past 12 months the home has developed its services further to include services for intermediate treatment and short break for older people and those with dementia care. Contracts have been established with Sunderland Royal Hospital and Sunderland Social Care Services respectfully and within these areas nursing care can be provided. The residential part of the home does not provide nursing care and any nursing needs are dealt with by the Community Nursing Services. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 5 New buildings within the home’s complex accommodate the new services. All areas offer disabled access with some restrictions on the upper floor of the main house. There is a large garden to the front of the home that can be used by service users and their visitors. There is easy access to a bus service, which offers services into the City Centre, where there is a range of services and shops. A detailed Service User Guide has been developed by the home and a Home Brochure is available. These documents provide clear information about what the service offers. A copy of these and a copy of the previous inspection report are available in the entrance hall to the home. The fee level for the home ranges between £407.00 and £422.00 per week depending on the individual assessed needs of the service users. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means that people who use this service experience excellent quality outcomes. This inspection was carried out over two days in July 2009 and was a scheduled unannounced Key Inspection. The inspection included a separate look at the Annual Quality Assurance Assessment (AQAA) completed by the proprietor. The care experienced by a sample of service users was ‘case tracked’. This is where the inspector focuses on the service provided for individual service users and time was spent chatting with service users and staff and observing life in the home. The environmental standards of the home were considered and a sample of staffing and service users’ records was inspected. The inspector took a midday meal with service users. The judgements made in this report are based on the evidence gained from this process. What the service does well: The friendly interaction of service users and staff creates a warm and welcoming atmosphere in the home. Good information is gathered about the needs of anyone wishing to move into the home or wishing to use any of the services within it. This means that the home can make an informed decision as to whether they can meet their needs effectively. Anyone interested in using the services are encouraged to visit the home and look around so that they can make an informed choice about moving in and using the service. When a decision has been made that this is the right place for the person to receive a service, the arrival date is well organized. Staff are identified to “meet and greet” the person and help them to become familiar with their new surroundings. This helps the person to feel welcome and safe. Care plans are put in place and these record details of the persons assessed needs. Clear guidelines lead staff to support the person in the way that they prefer and the way best practice dictates. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 7 Staff approach service users sensitively and support them with personal tasks discreetly. This makes service users feel confident, one said, The staff are really good they are very gentle and help me in a way that make me feel good. A good range of fresh food is available that is cooked well and served attractively. If service users have a special dietary need then this is addressed, for example, some people may need their food to be cut up for them or liquidised. Service users said:The food is always good. I like the food there is always enough to eat. Service users independence is promoted and they are supported to live a lifestyle that is based on their personal preferences. A variety of activities are arranged by people especially employed and who have interest and skills in this area. Activities are arranged in and around the home and service users are supported to visit local places of interests. Furthermore people are encouraged to maintain their interests and hobbies and go out independently if they are able. Visitors to the home are encouraged and service user comments include:“Our boys visit us regularly and they are made to feel very welcome.” My family are always made to feel welcome and staff keep them up to date with how I am doing. An enthusiastic staff team support service users to meet their individual needs and to develop and maintain their independence. So that staff develop the skills and knowledge needed, a good training programme is in place. The service is run by a clear management team who are each designated to lead staff teams that are responsible for the care provided throughout the home. Furthermore good systems are in place that monitor the quality of care delivered to ensure that it is in the service users’ best interests. What has improved since the last inspection? Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 8 The Statement of Purpose and Service User Guide have been reviewed and updated to reflect the changes and developments in the service. The range of fees charged is included in the Service User Guide and the full amount of fees charged by the home to individuals is included in their contracts. The way that the fees are broken down now makes it clear who is responsible for paying them and for what amount the service user is responsible. Care plans have been reviewed and developed and now demonstrate clearly how individuals’ needs are supported and met and furthermore plans to minimise assessed risks are included. Such plans are monitored monthly and reviewed annually when the service user, their family and the care manager are invited. Three activity organisers have been employed to develop and organise activities throughout the home. Service users now experience an active lifestyle and activity programmes are placed in visible positions around the home to inform people of what is going on. The environment is now more stimulating and easier to access for people who may experience dementia type illnesses. Pictures and objects that may promote reminiscence or activity that individuals’ particularly enjoyed in their past are tastefully and thoughtfully placed around the home. Pictorial signs to the bathrooms, toilets and dining areas help people to orientate themselves. Most staff have attended training regarding the local authority’s safeguarding adults procedures and plans are in place for those who have not. This means that staff know what action to take if they witness abusive practice or have an incident of abuse reported to them. Since the home has been extended the numbers of staff needed to meet service users’ needs has been reviewed to ensure that the resources needed are available throughout the home. Staff now are only employed following full CRB (Criminal Records Bureau) clearance and this ensures that they are “fit” to carry out their role as carers. So that the registered manager is always available to carry out her role effectively, she is not included in the number of staff needed to address service users’ needs. This means that she is available to oversee and monitor the running of the service and to supervise staff. What they could do better: A detailed record of complaints and concerns must be kept with the action taken to address them, so that service users and their families are confident that the home takes their seriously, Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 9 Any incident in the home that may affect a service user, including a serious accident, must be reported to the CQC (Care Quality Commission). So that only fully trained people support service users directly and unsupervised, the policies and procedures in place regarding the responsibilities of trainees, should always be followed. 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. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 10 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 Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with good information about the home and this helps them to make an informed choice about where they would like to live or receive a service. Preadmission assessments demonstrate service users’ needs and assist the home to make an informed judgement as to whether they can meet them. EVIDENCE: The home has developed a Statement of Purpose and a Service User Guide. Both documents have recently been reviewed and updated to ensure that they include current information about the service. The Service User Guide includes the range of fees charged by the home. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 12 Service users are given contracts that include the terms and condition of their stay and this includes a break down of how the fees are paid, clearly demonstrating the actual amount the individual is responsible for paying. Prior to accepting a person into the home a full assessment of need is carried out by the referring agency and the home. This is to ensure that the home receives as much information about the person as possible, so that they can effectively judge whether they are able to meet their needs. The assessments are kept in the service users care files so that they can be easily accessed. Those received for service users who recently moved into the home are comprehensive and cover all aspects of their health and social care needs, they also identify assessed risks. The intermediate treatment part of the service is located in a separate building known as The Mews. This is a new building specially built to accommodate people who may have disabilities and who may need therapeutic support prior to returning home. The people who use the service have access to kitchen areas, lounges, bathrooms with specialised bathing equipment and treatment rooms. Specialist staff are employed to carry out therapy treatment developed around individual need and special aids and equipment are in place for the occupational therapists and physiotherapists to carry out their work appropriately. This part of the service is separated into two units and both are directly managed by a registered nurse. The care staff who support the service users are trained in relation to their work and guided by the professionals and nurse in charge. There is a clear criteria set by the NHS Foundation Trust for people discharged directly from hospital to the Intermediate Treatment Centre. There are also set procedures in place that must be followed during the discharge transfer. These include the following documents to be in place; a transfer care document, an infection screening tool, a copy of the discharge form and any dressings or equipment required i.e. walking frames, feeding equipment and continence aids. On the day of transfer a verbal handover over the telephone takes place between the nurse in charge at the hospital and the nurse in charge at The Mews. The Mews has a policy only to accept patients if the criteria has been met and the set procedures followed. Social profiles are also developed at the assessment stage and these are included in the service users’ files. Separate documents called “My Perfect Day” Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 13 and “Activities I Enjoy” which have been developed by one of the home’s managers, are also completed at this stage and these inform the reader of the individual’s likes, dislikes and preferences regarding their preferred daily routines. These documents include important information about the person and their history, including the way they prefer to live and the things they enjoy doing. Such information can be useful to refer to when service users need support from staff to make decisions and choices about their lives. All of the information gathered at the assessment stage is used to develop individual care plans. In the residential care part of the home a six week review with the care manager, the home and the service user, confirms that the person is happy with the service provided and that they wish to stay at the home permanently. For those people attending the service for short break or intermediate treatment the time of stay is identified prior to admission but in some cases there is some flexibility regarding this. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans that are accessible and in good detail, guide staff to effectively address service users’ social and healthcare needs in a flexible and respectful manner and that promote their dignity and their right to privacy. Medication arrangements are appropriate to service users’ needs and are managed safely. EVIDENCE: The home has developed a clear care plan format that is accessible and effective. This is used with the assessment document to ensure that the identified care needs and risks are addressed. The care plans are developed in good detail and appropriately guide staff to support individual service users in their preferred way. Comments from service users include:Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 15 “The staff are very good, I cannot complain about the way the girls support me.” “The staff support me in a way that helps me to keep my independence.” Individual risk assessments are in place and clear risk strategy plans guide staff to minimise the identified risk. Such plans are used as an integral part of the care plan. Although staff are trained to carry out their role effectively and to address their duties professionally, they are aware of their limitations and gain further advice from specialist healthcare professionals, for example district nurses, GPs and specialist nurses. Furthermore records are kept of individual healthcare visits and appointments with the outcomes. District nurses keep their notes separate to the homes care files when visiting service users, but clearly communicate advice and guidance to staff relating to service users needs. Such advice is recorded in the daily notes and then transferred to the care plan if appropriate. One care plan recorded advice given regarding pressure relief and the risk strategy plan in place guided staff to encourage the person to regularly change position and for the person to be assisted to wash and apply cream after visiting the bathroom. When needed the daily intake of food and fluid is recorded on a separate sheet. This is in response to the completion of a malnutrition screening tool which is carried out when a risk assessment identifies a dietary need. One care plan recorded the need for food to be cut up for the person, a plate guard to be used and the person’s food in take and their weight to be recorded and monitored. Both were in place. If falls occur these are recorded in the person’s daily notes and professional advice regarding any injury caused is sought, for example, the advice of a GP or a district nurse. If the home continues to have concerns about the person further advice is sought from hospital accident and emergency units. Such incidents are recorded in the person’s daily notes. The healthcare practices in The Mews are monitored daily by the unit manager who is new in post and who has recently carried out an audit of issues raised by service users and their families/advocates. As an outcome, the procedures within the unit have been reviewed and modified resulting in improved care practices. The manager works closely with the matron for Rehabilitation and the Elderly from Sunderland Royal Hospital, who visits the unit weekly to address nursing Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 16 issues, observe meals being served and care practices. The matron’s visits are unannounced and includes weekends. Comments made by the matron include:“I cannot criticise the nursing care, it is very good.” “There has been some excellent feedback from patients and their families.” “The atmosphere is always very pleasant and the staff are very helpful.” Care plans are monitored and evaluated monthly and it is at this stage that changing needs are addressed and care plans adjusted if needed. Comprehensive medication policy and procedures are in place that are based on those set out by Sunderland Health Housing & Adult Services for the receipt, record, storage, handling, administration and disposal of medicines. All senior staff who are responsible for administrating medication follow these. Incoming and outgoing records of medicines are kept and audited monthly and all senior staff are trained in HSC375 Safe Handling of Medicines. The home complies with the administration and storage of Controlled Drugs, which complies with the Misuse of Drugs Regulations 1973. Receipt, administration and disposal of Controlled Drugs are recorded in the Controlled Drugs Register. Advice regarding medication is sought from the pharmacist who supplies the home if needed. Records are in place signed by each service user who receives support with the administration of their medication from the home, to confirm the arrangements in place. Clear guidelines for those who administer medication independently are also in place and these protect both the service user and others from risk of harm and a locked facility in the bedroom ensure safe storage. Staff are trained to identify any side effects or reaction to medication and seek advice from the service user’s GP. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff support service users to live the lifestyle of their choice and activities in the home are developed and arranged around their needs and aspirations. Good contact with family and friends is encouraged and service users dietary needs are addressed individually with the provision of good quality food, therefore promoting service users’ health. EVIDENCE: The different lifestyles and routines preferred by service users are respected and reflected in the separate documents “My Perfect Day” and “Activities I Enjoy.” These documents are used as a base and as important information when developing care plans. Promoting independence is encouraged throughout this service and service users who are physically able to move around the home do so with ease and confidence and those less able are supported by staff to access parts of the home of their choice. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 18 One person said, I haven’t been here long but staff know where I like to sit, I prefer to be beside the window where I can watch the ducks walking up and down and if I want to go back to my room I just have to ask.” A relative said, “My X is only here for a short break but they are included in activities and when the weather is nice they are supported to go out into the garden where they can play bowls or just sit and have a cup of tea.” All service users are encouraged and supported to use the extensive grounds and gardens surrounding this service. A recent project named “A Breath of Fresh Air” demonstrated how this can be achieved. Photographs and accounts of activities enjoyed over a week in the summer months showed how the home can provide meaningful activity outside. The grounds surrounding the home provide many stimulating activity. On the day of the inspection one person was walking along the drive looking for squirrels that live in the trees and others had fun watching the ducks that live in and around the gardens and the pond. In addition to these regular attractions, a hedgehog had been spotted in the garden. One service user enjoys working in the garden and small summer house. Service users discussed a recent barbecue and summer fayre that had taken place and that was very well attended by service users their families and friends and also the local community. Photographs displayed around the home reminded people of the event and other activities that take place. The home has its own mini bus which enables service users to enjoy trips out. Service users discussed visits to Whitworth Hall where they can feed the deer and to a farm where they can feed the animals, they considered that these were two of their favourite places to visit. The handy person showed their enthusiasm in driving the bus on such occasions and stated that they loved that part of their job as “the residents love it and get so much from it.” Three activities coordinators are employed to develop and organise activities throughout the service. All come from professional backgrounds and have experience and understanding of older peoples’ needs. They work closely with the care staff to ensure that service users have access to stimulating activity. One activity organiser said; “Sometimes I might set up a group activity that can be supervised by a carer, this gives me time to give a service user 1:1 time which might involve sitting in discussion or reminiscing or walking around the grounds. Service users from the short break services and the home were encouraged to gather in the garden for cold drinks and activity. Activities are varied according to service users’ needs and the dementia care units have been developed to ensure that stimulating objects, pictures and prompts for orientation purposes, have been thoughtfully and carefully placed. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 19 One service user said:“I like to have my own routine which I stick to, I always sit here, sometimes I join in activities but other times I just like to be on my own.” Visitors are welcome in the home at any time and they are invited and encouraged to join in the daily life and social events in accordance with the service users wishes. However so that service users’ dietary needs can be monitored effectively visitors are asked not to visit during meal times. However if this is the only time they can visit then special arrangements are made. Comments from visitors include:“This is a lovely place to visit we are made to feel very welcome.” “The staff here are very good they are always willing to give you time.” Each service user is given a personal food/drink choice brochure which is illustrated with photographs of different foods. Staff support service users to identify the sorts of foods they enjoy and from this a four week menu plan is developed making sure that individual preferences are addressed. A variety of meals are served with choices given at each meal time and during the day a variety of drinks and snacks including portions of fresh fruit are available. Special diets are catered for and also any dietary supplements and special requests. The cook liaises with the carers and nurses to ensure that all dietary needs are catered for appropriately and also interacts with service users to find out what they think about the food served. An audit of the food served is currently being carried out to ensure that the food is of good quality and the portions served are nutritionally and economically effective. Tea making facilities are provided in service users’ rooms for those who choose to have it and sherry is served before Sunday lunch with other alcoholic drinks served for social occasions. All of the dining areas throughout the service are attractive and comfortable. Tables are attractively set using good quality linen, crockery, cutlery and condiments and service users are given appropriate assistance where needed. A midday meal was taken with service users, there was a choice of food which was of good quality and attractively presented. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 20 Service users made the following comments:“The food is always good.” “If you don’t like something they will give you something different.” Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate and transparent arrangements are in place to protect service users from abuse and to address complaints and concerns about the service. EVIDENCE: Service users are issued with a copy of the home’s Complaints Procedure and this is kept in their individual care file. Service users confirmed that if they have any concerns they discuss them with the manager or the staff and they put things right. Visitors to the home also confirmed this. The complaints procedure is robust and comprehensive and is kept at the front of the Complaint’s book, so that staff have clear guidelines to follow when recording in it. The complaints recorded since the last inspection clearly state the actions taken to address the issues raised. Concerns reported to other agencies and known to the service have not always been recorded as a complaint. A discussion took place with the manager regarding concerns and complaints and although concerns are addressed directly, to show everyone that they have been taken seriously, they should be recorded in the same way as a complaint. This advice was accepted. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 22 Care practices are sound and meet the needs of the service users, hence the relatively few complaints made about the service. Furthermore, the current manager of the service has carried out an audit, the outcome of which is that key objectives to be used for further developing the service have been identified and this is proving to be a positive way forward in improving the service. The majority of staff have attended recent training regarding the local authoritys procedures on safeguarding adults and there is a rolling programme in place for the remaining staff to attend. In relation to safeguarding, staff have also attended training regarding the Deprivation of Liberty and copies of both policies and procedures are kept in the home for staff to refer to. Service users said that they felt safe living and staying at the home and trusted the staff to care for them in a dignified way. Service users said:The staff are good, they treat you with consideration and talk to you nicely. “We have always been treated kindly our sons visit us and they are happy that we are well cared for.” There are robust procedures in place for the handling of service users monies. Fees are paid to the home directly through the bank and any money kept by the home for individual service users, is kept with individual records that are open and clear. Receipts are kept for all transactions and if the money exceeds an agreed amount, the excess is given to the service users family to bank. Some service users take charge of their own money and have locked facilities for the safe storage of it in their rooms. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the 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 is clean, warm and well maintained offering service users a homely and safe environment in which to live. EVIDENCE: The home has recently been extended to accommodate a range of different needs. The new buildings meet building regulations and comply with the requirements of the fire and environmental services. Furthermore the individual needs of the service users are met. All of the areas in the new buildings are accessible to people who may use wheelchairs or who may have difficulties climbing stairs. Automatic doors at the entrance of the building are available and lifts assist service users to access the first floor. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 24 Although the new buildings surround the original building of Sycamore Lodge much of the original attractive grounds remain, this includes the long tree lined drive up to the house. The maintenance of this drive is an ongoing issue between the provider and the local council. The maintenance of the top part of the drive is the responsibility of the home and the bottom part is the responsibility of the local council. Although the part that is maintained by the home is in good condition the other part includes many pot holes making it very difficult and uncomfortable for people who use wheelchairs and for passengers in vehicles. In addition to this it is a hazard for people on foot. The manager continues to negotiate with the council about this issue. A newly built centre attached to the main part of the home now provide intermediate care for people who still need therapeutic treatment as part of their early discharge programme from Sunderland Royal Hospital. Service users are accommodated with individual bedrooms that are furnished to a high standard and that include facilities that meet the individuals’ needs, for example profiling beds and hoists. There is a treatment room with different exercising and therapy appliances and equipment where physiotherapists and occupational therapists can carry out their individual therapy treatments. Attractive dining areas are also available, one in a conservatory overlooking the gardens, where service users can dine in comfort with the amount of support needed. All such areas promote service users dignity and privacy. Comments from service users include:“It’s a lovely place to be.” “This is a lovely place to eat,” (reference to the conservatory.) “It is always extremely clean.” Although the original part of the building has been completely refurnished since the new buildings have been introduced, it retains its former character. New furniture, flooring and decor have maintained the high quality of the environment throughout and have provided service users throughout the service with an environment that is comfortable, very pleasant and safe. The style of chairs that service users use is dictated by their needs. Some service users with complex physical needs use recliner chairs that promote their comfort and dignity. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 25 One recent concern raised was in relation to the danger of the wood flooring for example, people falling and chairs and furniture sliding causing possible accidents. All chairs and tables are now provided with non-slip pads to avoid this happening. One service user commented that they find it easier to manoeuvre their chairs away from the table since the wood flooring was provided, making them more independent at mealtimes and a member of staff commented that they thought the flooring made it easier for service users to move around the home on foot and in wheelchairs. Service users and visitors commented favourably about the flooring and the new furnishings. The home monitors the number of falls in the home, where they happen and why. People with dementia care needs are accommodated in both the new and old buildings for both short breaks and permanent residential care. Much thought has been focussed towards making these areas stimulating and easy to access. Photographs of old film stars, the royal family and old areas of Sunderland, including places where people would have worked, decorate the walls in different areas and provide stimulation for reminiscing and discussion. Service users can identify their individual rooms from old photographs of themselves that were taken at stages in their lives that they remember and that have been framed and pinned to their doors. Different stimuli for activity are placed thoughtfully around the area and pictures on bathrooms and toilet doors guide people and promote their independence. A newly built bungalow that provides seven beds is at the moment unoccupied but the home is currently negotiating possible contracts with different health services for this facility. Plans have been submitted to the local council for further building in the grounds and currently work is going on to convert the old laundry into an extra bedroom in the old part of the building. The provider has informed the necessary agencies regarding these plans and ongoing work. The home is extremely clean and tidy throughout. Domestic staff are managed well and led by a designated housekeeper who monitors the effective cleaning routines. An infection control policy has been developed with the advice and guidance from Sunderlands clinical nurse specialist. The policy is in depth and includes procedures to follow when working with people with MRSA, clostridium difficile and when transferring service users to hospital care settings; it also includes procedures to follow during a break out of a pandemic influenza type illness. So that everyday hygiene is kept to a high standard the general cleaning schedules, that are regularly monitored, have been included in the policy. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 26 The staff team have received training regarding the infection control policy and procedures and carry out their duties in relation to them. The excellent standard of the cleanliness throughout the home reflects this. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 has a competent and qualified staff complement who effectively meet the care needs of the service users. EVIDENCE: Staff work with enthusiasm and interact with service users in a warm and professional way. Service users made the following comments:The staff provide excellent care, and staff are always there to help.” Some of the staff have worked at the home for many years and know service users very well and although there have been some staff who have retired or moved on for different reasons, new staff have been employed to fill their posts. The home accommodates trainees from the Springboard training scheme who work alongside trained carers. There is a policy in place that states how they are employed within the home and this states that trainees support trained carers to carry out tasks and they are not expected to carry out personal tasks unsupervised. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 28 However it is accepted that as trainees become competent they may assist with personal tasks. Although there has been a recent incident reported where a trainee took a service user out of the home unsupervised, this is generally not the rule. This incident has been addressed by the home and clear procedures are now followed regarding how trainees are deployed and supervised. The scheme has been very successful for many of the trainees taking part and some have moved into carers roles following the completion of their placement. One such trainee employed by this service and who has proved to be very successful has recently been nominated for the Trainee of the Year Award sponsored by the Sunderland Echo. The home has a diverse staff group with different experiences, expertise and qualifications. A varied training programme is in place for all staff that includes mandatory training and other courses related to their roles. A clear training matrix is in place and identifies when training needs to be updated. Over recent months staff have attended training including, dementia care, the safe administration of medicines, the Mental Capacity Act and the Deprivation of Liberty and infection control. Staff have also received training in good care practices and palliative care. There are many greeting cards in the home from relatives of service users complimenting the staff for the good care service users experienced at the end of their lives. The staff team are well qualified, over all of the service an average of 75 of the staff team has achieved NVQ and others are working towards it. In addition to this senior staff have achieved NVQ 3 and are working towards level 4 and all staff who are responsible for running the units in The Mews, where nursing care is provided, are qualified nurses. The domestic and kitchen staff team is also NVQ trained and qualified in health and safety, food handling and infection control. The service has opened a new training room in part of the new building that provides a dedicated facility where qualified trainers can deliver courses in house. The robust recruitment procedures carried out by the service ensure that the welfare and interests of the service users are protected. Fully completed application forms, 2 references and CRB (Criminal Record Bureau) checks are all in place. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 29 Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 30 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A competent and motivated management team and good and effective management systems ensure that the service is run in the best interests of the service users. EVIDENCE: To accommodate the recent change in registration the service has employed a second manager for the service specifically to manage The Mews and the Villa. She is well qualified in nursing and has had extensive experience in running services. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 31 However the manager of the Lodge remains the registered manager of the whole service. The service is currently providing care for 40 older people and dementia long term care in the Lodge and 52 short break elderly frail/dementia and intermediate nursing care in The Mews. The Villa that is equipped to accommodate 7 service users is currently not providing a service. The registered manager who is qualified in the Registered Managers Award (RMA) and has had many years experience in management, has an open door policy that enables service users, their families and staff to freely approach her for discussion, guidance and advice. She keeps up to date with changing legislation and improved ways of working and has recently attended training regarding the Deprivation of Liberty and Infection Control. The manager has worked closely with Sunderlands Infection Control Nurse to develop and implement policies and procedures in the home regarding good care and hygiene practices. She has also attended training regarding dementia care. The registered manager works closely with the director of the service and the manager of The Mews. All share ideas and work closely with service users and staff to establish a service that is developed in the service users’ best interest. Senior nurses directly manage the two units in The Mews and senior staff directly manages the units in the Lodge. Positive and respectful relationships have developed between the manager, service users and staff and effort to promote good working relationships between all, has been successful. Appropriate health and safety records are maintained and this demonstrates that all staff receive regular and appropriate training in fire procedures, moving and handling and first aid. Records are kept to record hot water temperatures and thermometers are in place in each bathroom for staff to test hot water. Records are kept of any accident in the home and individual records including the action taken and the outcome, are kept in individual service users care files. It was noted that one such accident that had happened in the home and had needed medical attention had not been reported to the CQC in compliance with Regulation 37. This was brought to the attention of the manager who took note. The service accepts that this was an oversight, the exception rather than the rule and will ensure that this does not happen again. The home has worked hard to develop an effective quality assurance system that is based on the National Minimum Standards. Each outcome is used to monitor the standard of the service delivered. Good monitoring systems are in Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 32 place and where action has needed to be taken, details are recorded demonstrating how the service has improved. In addition to this a quality assurance system is being developed to address concerns and complaints so that there is a system in place that focuses on areas to be improved. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 33 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 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No 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. OP16 Standard Regulation 22 Requirement The registered manager must ensure that all complaints made to the home are recorded appropriately so that it is evident that they have been taken seriously. The registered manager must ensure that all incidents in the home that may affect service users are reported to the Care Quality Commission (CQC). Timescale for action 31/08/09 2 OP38 37 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP27 Good Practice Recommendations 1. The registered manager should ensure that trainees working at the home follow the set policies and procedures in place regarding their role and do not support service users without supervision. Sycamore Care Centre DS0000015741.V376623.R02.S.doc Version 5.2 Page 35 Care Quality Commission Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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