Care Home: Sycamore Hall Care Home

What the care home does well People told us that the food they were offered was `lovely`. One person said, "We get a really nice choice, the meat today was lovely". We were told that the staff were kind and people said that they were well looked after. The inspectors observed good interactions between the staff and the people who live at the home, it was clear that staff had a good understanding of the support and care that people required. Staff spoke to people in a friendly and reassuring manner, and people responded well to this. We observed how staff explained what care or interaction they were going to assist people with in a discreet and sensitive way. What has improved since the last inspection? Since the last inspection there has been a big improvement in the way in which people are supported and cared for at the home. People`s medication is now stored and administered safely and staff have had training in medication administration. The pharmacist inspector visited the home and did an inspection. She was satisfied with the way in which people`s medication is looked after and administered. We saw staff treating people with privacy and dignity. When we spoke to staff they were very clear about how care should be delivered to people in a dignified manner. The meals at the home have improved greatly a new chef has been appointed and people told us that the meals were "lovely". The routine at meal times has now been altered to enable people to get the right support and assistance from staff. An activities co coordinator has been appointed and we observed some activities taking place during the inspection. An activities care plan has been set up for each individual and details what hobbies and interests people enjoy taking part in. At this inspection we found the home to be clean and tidy and some areas have been refurbished and redecorated, some new furniture and equipment has also been bought for the benefit of the people who live at the home. What the care home could do better: Although it has been acknowledged that there has been a considerable amount of work already undertaken at the home the manager must now concentrate on completing care plans and risk assessments on all the people who live at the home. Once this has been completed she must assure herself that the care plans and risk assessments are appropriate to meeting the identified assessed needs of the people who live at the home. There are very few permanent nurses who are employed at the home. The manager needs to provide a skilled and competent workforce in sufficient numbers to ensure that people are cared for and supported properly. The manager must look to implementing a quality assurance system at the home. This will ensure that the views of the people who live at the home are listened to and acted upon, so that people receive the service they want. As yet the Commission has not received an application from the manager to become registered with us. She must now do this without delay so the service can move forward and she can take accountability for the service. Key inspection report Care homes for older people Name: Address: Sycamore Hall Care Home Kearsley Road Ripon North Yorkshire HG4 2SG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bridgit Stockton     Date: 0 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 22 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: Sycamore Hall Care Home Kearsley Road Ripon North Yorkshire HG4 2SG 01765606025 01765609437 liz@premiernursinghomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Premier Nursing Homes Limited care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Sycamore Hall is a care home providing nursing and personal care for up to sixty two people who suffer from dementia. The nursing unit of 32 beds is located on the first floor and the residential care unit of 30 beds is on the ground floor. It is a modified and extended building, which was previously part of Ripon College and in the past was used as a Hall of residence and latterly, a conference centre. It is built on two floors, and there is a vertical lift providing level access to the first floor. There is car parking provided at the front of the building. There are landscaped areas to both sides and two enclosed, part paved garden areas. The home has a brochure which is available for people before they move into the home. People are given further information in the service users guide once they are admitted. A copy of the inspection report is available in the front entrance of the home for those who wish to look at it. The fees range from £400.36 to £758 .00 per week. Care Homes for Older People Page 4 of 22 Over 65 62 6 0 9 1 2 2 0 0 8 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The purpose of this inspection was to assess the quality of the care and support received by the people who live at the home. We also looked at the progress that had been made at the home with regard to the requirements that were made at the previous inspection. The methods we used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 5 of 22 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 6 of 22 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 22 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they will be properly assessed prior to moving into the home, to ensure that their care needs can be met within Sycamore Hall Care Home Evidence: At the last key inspection we asked that people are properly assessed by the home before being admitted, and that any documentation associated with the admission be completed fully. We also asked that staff are told about any new admissions to the home and that they are informed of what care and support the person requires in order to have their care needs met. At this inspection we were shown pre admission documents that the manager is going to be using when assessing people to see if they can be supported and cared for safely at the home. The manager explained that as yet this new assessment document has not been used, because there have been no new admissions to the home. The manager also told us that she plans to brief staff on the unit when a new Care Homes for Older People Page 9 of 22 Evidence: admission to the home is expected, and go through the assessment in order that staff are aware of what care and support is expected from them. As this documentation and assessment process has not been used as yet is is difficult to comment on how effective it will be. Care Homes for Older People Page 10 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are being met in a dignified way. Some associated documentation regarding peoples planned care requires further review and amendment. Evidence: At the last inspection the recording of how people were cared for was very poor. At this inspection we looked at five care plans in detail and randomly sampled several others. There was a significant improvement in how peoples care was recorded. The plans and risk assessments were up to date and had been reviewed on a regular basis. There was documented evidence of involvement of specialist healthcare people such as the community psychiatric nurse, the dietitian and continence nurse. Instructions that had been given from these health care professionals had been incorporated into peoples care plans. Staff were able to give a very good account of what care people required and confirmed that they had read peoples care plans and were now involved in planning peoples care. There were still some care plans and risk assessments that need updating and evaluating and the manager must monitor how this is progressing. She must also start to monitor and audit the plans to assure herself that this documentation is kept up to Care Homes for Older People Page 11 of 22 Evidence: date and that people are in receipt of properly plan care. Ensuring that staff have available up to date information in order that they can provide the correct planned care. In addition the plans need to demonstrate that either the person or their advocate has looked at and agreed with the plan of care that the home is providing. We saw that peoples privacy and dignity was maintained by the staff on duty. We observed one member of staff discreetly ask a person if they needed assistance to rearrange clothing. We observed staff knocking on peoples bedroom doors before they entered and draw curtains in peoples bedrooms when they were assisting with personal care. We asked a pharmacy inspector to visit the home to check on how peoples medication was administered. We did this because at the previous inspection we had asked the home to make sure that if they were looking after peoples medication for them, it was done safely and people were given medication that was prescribed for them only. The pharmacist was satisfied with how peoples medication was being administered at the home. She was satisfied that peoples medication was now managed properly by the home. Care Homes for Older People Page 12 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Where possible people are given choice over how they spend their days. Evidence: Since the last inspection an activities coordinator has been appointed. During this inspection she was organising a game of bingo, some people from both floors attended this. People told us they had really enjoyed themselves. Extra staff were available to help some people were needed. One person was really pleased they had won and showed us their prize, they said it was good fun, I use to play bingo, this is the first time Ive won anything. We observed the lunchtime meal on both units. It was more organised that it had been on the previous inspection. The upper unit now serves meals in two sittings. This enables the people who require assistance more time and the correct support they need. A new cook has been appointed in addition to the existing catering staff. He has introduced new menus and make sure he knows what peoples preferences are and what special diets are required. One of the inspectors sampled the meal. It was braised steak, potatoes and vegetables. She said it was very nice and the meat tender. Care Homes for Older People Page 13 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safeguarded and their concerns and complaints listened to and acted upon. Evidence: At the last inspection we asked that all staff were trained in the protection of vulnerable adults (POVA). We asked staff about this at this inspection.Some staff said they had been given POVA training and the manager confirmed that all staff are to be trained by January 2010. All agency staff spoke to had received a full induction into the home and POVA had been covered in their induction. We looked at how complaints are being managed and how they are being investigated. We found that one complaint that had been outstanding for sometime had been resolved and the complainant was satisfied with the outcome. Care Homes for Older People Page 14 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable enviroment. Evidence: We looked around the environment and found it to be a lot cleaner and tidier that it had been at the previous inspection. Some flooring has been replaced in bedrooms and some new furniture bought for the communal areas. The company employ a head of domestic and environment services who was also at the home during the inspection. The manager told us that she was about to implement some new cleaning schedules and domestic rotas that he had recommended. He had also given advice and training to the domestic staff who were on duty in the home regarding deep cleaning and product selection. Care Homes for Older People Page 15 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst staff training has improved, the recruitment of permanent members staff needs to continue to ensure that peoples needs are met by a skilled work force.. Evidence: Since the last inspection the number of permanent staff who are employed at the home has increased. Currently there are very few permanent members of staff who are trained nurses. The recruitment of these staff in key to ensure that improvement is continued. The manager confirmed that agency staff are still used but every effort is made to make sure that it is the same members of agency staff who work at the home. This helps in the continuity of care for people at the home. We were told that a company is been used to recruit and train staff on behalf of the home. All new members of staff will be given an induction and all basic training in such areas as health and safety, basic first aid, protection of vulnerable people and moving and handling will be given before staff start working at the home. Staff training has continued. Some staff have attended safe medication handling, protection of vulnerable people and first aid training. Also some staff have attended training in care planning and risk assessment. Care Homes for Older People Page 16 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would be better served by having a registered manager at the home, who can sustain the improvements and drive up the quality of care people receive at the home. Evidence: Since the last inspection the manager has worked hard in trying to meet with the requirements that were made. The whole staff team have worked very hard and improvements were seen in all areas. The manager must now consider how to sustain this improvement and measure the quality of the service the home is providing. As yet we have not received an application from her to become the registered manager of the home. This application should be submitted to us without delay. We checked a sample of health and safety certificates. These were up to date. Staff had received recent training in health and safety and in fire and rescue procedures at the home. Care Homes for Older People Page 17 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 18 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 In order to keep people safe, risk assessments must be kept under review and demonstrate how identified risks are managed. This will make sure that people are looked after safely and any risk to there safety is identified and either eliminated or safeguards put in place to manage the risk. 08/03/2010 2 7 15 The manager must continue 08/03/2010 to make sure that all care plans are accurate and up to date with the recording of what care is to be provided for people. This will make sure that all staff have accurate care plans available, to instruct them on how to meet peoples identified needs. 3 18 18 The manager must make sure that all staff have had 08/02/2010 Care Homes for Older People Page 19 of 22 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action safeguarding training. She must demonstrate that she is satisfied that staff have fully understood the training and be confident that they would know what to do in the event of someone being subject to abuse. This will make sure that people are kept safe from any form of abuse 4 27 19 The home must employ suitable skilled and trained nurses in sufficient numbers to ensure people are cared for properly. This means that peoples identified nursing needs will be met and their care supervised by a trained nurse, at all times. 5 33 12 A quality assurance system must be devised to ensure that the service that is offered to people is to there satisfaction This will make sure that people are in receipt of a service that thy want and are happy with 30/04/2010 22/03/2010 Care Homes for Older People Page 20 of 22 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 31 The manager needs to apply to the Commission to become the registered manager of the service. Care Homes for Older People Page 21 of 22 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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