Care Home: Sycamore House

Similar services:

• Abbey The
• Snydale Care Home
• Hawkhills
• Larchfield Manor
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well The home provided a clean and safe environment for people. People told us they were happy with their home. A redecoration and refurbishment plan was in place and the home was well maintained. People always had their needs assessed prior to admission so staff knew they were able to support them. People said the staff team were friendly and supported them in ways that respected privacy and dignity. They knew the managers name, which told us she gets out and about the home. Visitors were welcomed at any time of the day and this was confirmed in a discussion with people that live in the home, staff members and a relative. Residents continue to like the meals and drinks provided. There were choices on the menus and people stated they could have alternatives if they didn`t like what was on offer for the main meal. The home had been awarded parts 1 and part 2 of the Local Authority Quality Development Scheme for ensuring care plans and a quality monitoring system was in place. Any complaints were looked at straight away and sorted out, and the home managed peoples` finances appropriately. Staff members were supervised to make sure they were doing their job properly. What has improved since the last inspection? The manager had completed all the requirements issued at the last inspection. The homes statement of purpose and service user guide had been updated to enable people to make an informed choice about the home. Care plans and risk assessments had improved, which gave staff clearer instructions about the care that was required. One persons care plan still needed specific information. See below. How the staff managed medication had improved, which ensured that it was stored correctly and people received what was prescribed for them.Sycamore HouseDS0000070917.V376767.R01.S.docVersion 5.2The activities provided had been broadened and people with dementia care needs received more one to one attention. This helped to ensure that people were not bored and improved the choices they were able to make. Staff recruitment and training had also improved. New staff members were supervised very closely in the exceptional circumstances when they employed prior to the return of full checks. The manager had also initiated resource packs with questionnaires to all staff that included information about conditions affecting older people. This gave staff a basic understanding and enabled the manager to see where further training was required. The percentage of staff trained to national vocational qualification (NVQ) level 2 and 3 had increased to 57%. This is a very good achievement. The quality assurance system was new last year and has been implemented during the last twelve months. The process of audits and questionnaires to people ensured that systems within the home were monitored and people consulted about how the home was operated. Identified shortfalls were addressed. The records required for the safe running of the home and staff had improved the way they documented things. All staff followed moving and handling guidance and we did not observe any unsuitable techniques used. What the care home could do better: The home had spent time collating information about a residents` specific behaviour. This information needs to be put into their care plan so staff members have clear guidance and can all follow the same approach. This was an issue at the last inspection and the manager did develop a behaviour management plan for that resident. The issue this time is mainly one of timing and we discussed how long the monitoring should take place before a behaviour management plan needs to be completed. Care plans had improved regards content and staff instructions. However, it was company policy not to develop a care plan when a resident was deemed to be independent in a specific task. This needs to be reviewed, as independent living skills need to be reflected in care plans so staff are aware of them and can work towards maintaining them and encouraging the development of new skills. The manager should incorporate skills for care common induction standards into the homes induction process. This will enable staff competence to be assessed and signed off on completion.Sycamore HouseDS0000070917.V376767.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Sycamore House Wawne Road Bransholme Hull East Yorkshire HU7 5YS Lead Inspector Beverly Hill Key Unannounced Inspection 22nd July 2009 09:00 DS0000070917.V376767.R01.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 House DS0000070917.V376767.R01.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 House DS0000070917.V376767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore House Address Wawne Road Bransholme Hull East Yorkshire HU7 5YS 01482 878398 01482878698 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) Sycamore Care Ltd Miss Teresa Montana Care Home 36 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (36) of places Sycamore House DS0000070917.V376767.R01.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 only - Code PC, 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 falling within any other category - Code OP; Dementia - Code DE The maximum number of service users who can be accommodated is: 36 22nd July 2008 2. Date of last inspection Brief Description of the Service: Sycamore House is located in the Sutton area of Hull close to local facilities and bus routes. It provides personal care for up to thirty-six people including those who may have dementia care needs. The home is owned by Sycamore Care Ltd. The home is purpose built with all facilities and services at ground floor level accessible to wheelchair users. There are three lounges, one of which is quite small and used for people that wish to smoke, and a large dining room. There is also a kitchenette for relatives to make refreshments and a separate room for the hairdresser. Thirty-four of the bedrooms are single rooms, none of which have en-suite facilities. There is one shared bedroom. The home has five bathrooms, one of which has an assisted bath. In addition there is a walk-in shower room. There are sufficient toilets throughout the home and close to communal areas. The home benefits from car parking space to the front and an enclosed lawn and paved area to the rear leading from the dining room. The garden has recently been landscaped and provides a very pleasant area for residents. The home is clean, tidy and welcoming. According to information received from the home the weekly fees are between £359.50p and £389.55p. There is a third party top up system of £17 each week but this can be negotiable. Additional charges are made for hairdressing, chiropody, transport, newspapers, nametapes, holidays and outings, and alcohol and cigarettes. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 5 Information about the home and services can be located in the statement of purpose and service user guide, available from the manager. Each resident also has a copy of the service user guide in his or her bedroom. Sycamore House DS0000070917.V376767.R01.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 2 stars. This means that the people who use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection of the home on 22nd July 2008 including information gathered during a site visit to the home. This site visit started at 9am and finished at 6pm. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Sycamore House. We also had discussions with the registered manager, staff members and a relative. Information was also obtained from surveys received from ten people that live at the home, five relative, nine staff members and two visiting professionals. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We checked how staff monitored the food and fluid intake of those with nutritional risks. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Sycamore House, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. 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 the services are not being put Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 7 at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the service does well: The home provided a clean and safe environment for people. People told us they were happy with their home. A redecoration and refurbishment plan was in place and the home was well maintained. People always had their needs assessed prior to admission so staff knew they were able to support them. People said the staff team were friendly and supported them in ways that respected privacy and dignity. They knew the managers name, which told us she gets out and about the home. Visitors were welcomed at any time of the day and this was confirmed in a discussion with people that live in the home, staff members and a relative. Residents continue to like the meals and drinks provided. There were choices on the menus and people stated they could have alternatives if they didn’t like what was on offer for the main meal. The home had been awarded parts 1 and part 2 of the Local Authority Quality Development Scheme for ensuring care plans and a quality monitoring system was in place. Any complaints were looked at straight away and sorted out, and the home managed peoples’ finances appropriately. Staff members were supervised to make sure they were doing their job properly. What has improved since the last inspection? The manager had completed all the requirements issued at the last inspection. The homes statement of purpose and service user guide had been updated to enable people to make an informed choice about the home. Care plans and risk assessments had improved, which gave staff clearer instructions about the care that was required. One persons care plan still needed specific information. See below. How the staff managed medication had improved, which ensured that it was stored correctly and people received what was prescribed for them. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 8 The activities provided had been broadened and people with dementia care needs received more one to one attention. This helped to ensure that people were not bored and improved the choices they were able to make. Staff recruitment and training had also improved. New staff members were supervised very closely in the exceptional circumstances when they employed prior to the return of full checks. The manager had also initiated resource packs with questionnaires to all staff that included information about conditions affecting older people. This gave staff a basic understanding and enabled the manager to see where further training was required. The percentage of staff trained to national vocational qualification (NVQ) level 2 and 3 had increased to 57 . This is a very good achievement. The quality assurance system was new last year and has been implemented during the last twelve months. The process of audits and questionnaires to people ensured that systems within the home were monitored and people consulted about how the home was operated. Identified shortfalls were addressed. The records required for the safe running of the home and staff had improved the way they documented things. All staff followed moving and handling guidance and we did not observe any unsuitable techniques used. What they could do better: The home had spent time collating information about a residents’ specific behaviour. This information needs to be put into their care plan so staff members have clear guidance and can all follow the same approach. This was an issue at the last inspection and the manager did develop a behaviour management plan for that resident. The issue this time is mainly one of timing and we discussed how long the monitoring should take place before a behaviour management plan needs to be completed. Care plans had improved regards content and staff instructions. However, it was company policy not to develop a care plan when a resident was deemed to be independent in a specific task. This needs to be reviewed, as independent living skills need to be reflected in care plans so staff are aware of them and can work towards maintaining them and encouraging the development of new skills. The manager should incorporate skills for care common induction standards into the homes induction process. This will enable staff competence to be assessed and signed off on completion. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 9 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 House DS0000070917.V376767.R01.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 House DS0000070917.V376767.R01.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): 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. Prospective residents were provided with up to date information about the service in the homes statement of purpose and service user guide. This enabled them to make informed choices about whether the home was right for them Peoples’ needs were assessed prior to admission. This enabled staff to be sure the home was able to meet the identified needs. EVIDENCE: Since the last inspection the homes statement of purpose and service user guide had been updated to include full information about the services provided in the home. People were given copies of the service user guide and the statement of purpose was on display in the home. The manager confirmed Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 12 both documents were available in large print form. The home has also produced a brochure with added points of interest. The manager confirmed that they completed assessments of needs for people wishing to become resident in the home. The assessments took place at the persons’ own home, in hospital or at other residential homes. Assessments completed by care management staff were obtained for people funded by the local authority. We looked at four care files, two of which were for people recently admitted to the home. The care files evidenced that people were admitted only after their needs had been assessed. The homes documentation provided for an initial gathering of information, sufficient to base the decision about admission, which was followed by a more in depth assessment of the persons’ activities of daily living during the first few days of admission. For example, in one file examined the initial assessment was completed on a particular day, the person was admitted five days later and the more in depth assessment completed between one and three days after admission. There was evidence that the assessment was added to as more information became known to staff. Following the initial assessment the manager formally wrote to people advising them that their needs can be met in the home. The letters need to be dated. The assessment process provided staff with information when planning care for people. The home does not provide intermediate care services so standard six is not applicable. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 13 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): 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. Residents had their assessed needs planned for and met, which promoted their health and personal wellbeing. Medication was well managed, which ensured people received their medication as prescribed. EVIDENCE: There had been an improvement in care plans since the last inspection. Identified needs were planned for, staff had clear tasks regarding how they were to support people and care plans were evaluated and updated when significant changes in need occurred. Care plan reviews took place with care management and family members present. The company policy was that if the resident was not seen as having any needs in a particular area, for example if they managed to eat unaided and had a Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 14 normal diet, a care plan was not developed for that area. If residents are independent with particular elements of their care it is important that this is reflected in care plans to ensure staff are aware and that this independence is promoted and maintained. Personal profiles called, ‘this is your life’ were completed to give staff information about the residents likes and dislikes. This information was included in a précis of the residents’ routine and was held at the front of each care file to be used by staff as a quick reference guide. The document had not been completed in one of the care files examined and only partially completed in another. Risk assessments were completed for a range of activities and informed the care plans. The home also completed monitoring charts for food and fluid intake and pressure relief for residents deemed to be at risk. Some staff completed the charts more fully with the correct amount of fluid instead of using the terms, ‘cup’ or ‘beaker’. One residents’ behaviour that could be challenging was also monitored at the request of the community psychiatric nurse. This information now needs to form part of a behaviour management plan. There was evidence that peoples’ health needs were monitored and they had access to a range of health professionals for advice, support and treatment. Most people were weighed on a monthly basis and staff used an alternative method of monitoring for one resident who could not be weighed. The dietician had been involved in one of the care files examined. Daily recording had improved and staff members comment on each care plan issue after each shift is completed. There is also a tick box form for when personal care tasks are completed. Visits from relatives and health professionals are recorded and key workers record time spent with residents. People spoken with were happy with the care they received. Comments were, ‘we get looked after well’ and ‘I do a lot of things for myself – the staff shower me weekly’. Ten surveys were received from residents and all stated they received the care and support the required either, ‘always’ or ‘usually’ and that staff made sure they had access to medical care. A relative told us that the manager or other staff kept them informed of important issues. They also stated, ‘she always looks clean and presentable with hair done and nails clean and I vary the times of visiting’. The management of medication had improved since the last inspection. It was stored appropriately and staff recorded when medication was received into the home and when administered to people. There was a returns system for unused medication. The manager advised that some difficulties with obtaining medication in a timely way had been resolved with the aid of a Primary Care Trust Pharmacist and the home receives ongoing support from them. A Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 15 medication error for one resident was resolved quickly and measures put in place to prevent a reoccurrence. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that people were able to make choices about aspects of their lives and provided opportunities for social stimulation. The meals provided offered choice and met peoples’ nutritional needs. EVIDENCE: The home provided a range of in-house activities and an activity coordinator was employed for twenty hours a week. People participated in bingo, quizzes, games, painting, dominoes, exercise to music, sing-a-longs, birthday and other seasonal parties, watching films and craftwork. The activity coordinator told us how she supported people with dementia to join in group activities or spent one to one time with them instead, looking at photographs of family or listening to music. She told us that they had tambourines and shakers for people to use during sing-a-longs. The home recently had a BBQ that was well attended by residents and also enjoyed by some relatives, ‘we are invited to BBQ’s and sing-a-longs – we feel part of the family’. A resident told us, ‘we had a BBQ last week and I really enjoyed it, the food was excellent’. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 17 In surveys eight people stated they had enough activities, ‘always’ and two people said this was ‘usually’. This was an improvement from the last inspection and evidence that the staff members are getting it right for the majority of residents living in the home. One resident did comment that they would like to get out more and another said, ‘there are things to do – the activity lady comes in and I join in’. Some people obviously joined in more than others and choice was respected. One of the residents enjoyed playing the organ in the lounge. Staff in surveys stated they offered a, ‘good variety of activities’. Some connections with the local community have been maintained, for example, a lay person visits the home and holds prayers for those wishing to join in and an entertainer visits monthly. Weekly outings were arranged, weather permitting, and some people visited the local shops and pubs. People spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussions with staff and a relative who told us they were always made to feel welcome and offered refreshments. People were able to make some choices about aspects of their lives. Some people chose to continue smoking and facilities were arranged for this, some people managed their own personal allowance and some had keys to their bedroom doors to offer them privacy. Staff stated people had the choice of where to sit and have their meals, the times of rising and retiring and whether they preferred to stay in their bedrooms. One person said, ‘they don’t pressure you at all if you don’t want to do something’ and another person said, ‘you can mix or be on your own if you want’. A relative spoken with was very complimentary about the home stating, ‘I am over the moon that this is the one we have chosen – we feel she is at home, not, in a home’ People spoken with enjoyed the meals provided by the home. Out of ten surveys received three people stated they liked the meals ‘always’, six said this was ‘usually’ and one person stated, ‘sometimes’. Comments were, ‘good food’, ‘the meals are excellent – there are choices’, ‘I like most of the food – I had a salad instead of a curry’ and ‘I’m very happy with the food and putting on weight’. People said they had plenty to eat and drink and jugs of squash were seen in communal areas and bedrooms. The menus rotated over a four-week period and offered an alternative to the main meal provided. The cook told us that special diets and religious needs were catered for and food supplements obtained via residents own GP’s when required. Some days the home prepared three to four different choices for the main meal as the cook became aware of requests. Information about likes and dislikes is obtained from the resident or their family. The home had scored an Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 18 ‘A’ in Hull City Council’s ‘scores on the doors’ assessment system. This is a high score and means that the home practices safe food management. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 19 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): 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. The home provides an environment where people feel able to complain. People are protected from abuse and poor practice by staff training and adherence to policies and procedures. EVIDENCE: The home had a complaints policy and procedure and staff made sure this was on display in the home and provided in the service user guide. There was also a complaint form for residents, their relatives and staff to complete should any complaints be brought to their attention. The manager kept a log of complaints and in the last year there have been nine, of which eight were resolved. The Commission became aware of the last complaint and we have asked the area manager to send us a report of their findings when they report back to the complainant. In discussions staff members were aware of what to do and who to report issues to. Staff members stated, ‘we have a complaints form in the entrance – we don’t get very many complaints’ and ‘the manager deals with complaints’. Residents and relatives spoken with also knew how to complain, it’s a lovely home, she couldn’t have gone into a better place – I would go to Theresa, nothing is too much trouble’, ‘concerns would be sorted out quickly’, ‘I have no Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 20 complaints at all’, ‘I would see the seniors’, ‘if there was anything wrong I would tell them and they would sort it’ and ‘tell the boss’. Nine of the ten surveys received from residents stated they were aware of how to make a complaint. All ten stated they knew who to speak to if they were unhappy about something. Four of the five surveys received from relatives indicated they knew how to make a complaint and although one relative couldn’t remember they stated, ‘I would always ask the manageress’ The home alerted the local authority and the Commission promptly when there were any issues required to be reported. This enabled us to monitor the situations and check on how the home was managing them. There had been some issues between residents and risk assessments and behaviour monitoring charts had been completed to enable staff to formulate behaviour management plans. All staff had completed safeguarding of adults training and the manager has completed a safeguarding, ‘train the trainer’ course to enable her to facilitate training to staff. In discussions staff members were clear about what to do if they witnessed any poor practice or abuse and the manager is fully aware of her responsibilities in alerting, referral and investigation procedures. Since the last inspection the manager had reported one allegation to the local authority safeguarding team. This was regarding a staff member completing insufficient continence care. However, the local authority investigated and could not substantiate the allegation so no further action was required. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 21 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): 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. The home provided a clean and well-maintained environment for people to live in and enabled residents to personalise their bedrooms to make them more homely. EVIDENCE: The home is purpose built with all facilities and services at ground floor level and accessible to people in wheelchairs. Communal areas consist of three lounges, the smaller of which has now been made into the room for people wishing to smoke, and a dining room. The dining room is light and airy with individual tables and chairs set out with tablecloths and condiments. There is a kitchenette for relatives to make refreshments and one of the corridors has a seating area that some people liked to use to watch the comings and goings in the home. There is also a small seating area in the entrance. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 22 Improvements in the environment have continued on a rolling programme. Communal areas and bedrooms were nicely decorated and furnished in a homely way. The hairdressers’ room has been upgraded and looks like a traditional hair salon. The home had thirty-four single bedrooms and one shared bedroom, none of which have en-suite facilities. Bedrooms were personalised and people told us they were able to bring in small items of furniture and decorate their walls with pictures to make their rooms feel more homely. People spoken with were happy with the home in general and with their bedrooms, ‘I have my own things about me’, ‘I like my room, they clean it in the mornings’, ‘it’s a nice home – everything is nice about it’, ‘I love my room – I love watching the birds’. In surveys people were asked what the home does well and comments about the environment were, ‘provides a smoke room’, ‘the gardens are nice’ and ‘it’s kept clean’. The home has five bathrooms and one shower room, a sluice room and sufficient toilets appropriately placed throughout. The garden at the rear was a very pleasant space for people to sit outdoors and enjoy the warm weather. There were bird feeders outside particular bedrooms and one person told us they got so much pleasure from watching and feeding the birds. The home had sufficient laundry equipment and the environment was clean and fresh with no malodours. Nine of the surveys received from residents stated the home was fresh and clean, ‘always’. One person stated this was, ‘usually’. The home had three staff offices for management, senior care staff and administration. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by appropriately recruited staff. The company provides training and development opportunities for staff to enhance their knowledge and skills in caring for older people. EVIDENCE: Discussions with care staff members and information from rotas indicated that there were three carers and a senior carer on duty during the day, and two care staff at night. The manager was supernumerary and worked Monday to Friday but was part of an on-call system with the deputy manager. Since the last inspection the home has employed an administrator and the activity coordinator is more settled in their role. Staff members told us that they do not feel rushed when providing care. The home has a weekly operating report which looks at occupancy and from this calculates the number of care hours required. Comments from people about the staff were, ‘friendly staff’, ‘the staff are as patient going off duty as they are when they come on’, ‘the staff are very good’, ‘the carers work very hard providing care to vulnerable elderly people’, ‘they do just about everything well’, ‘they care well for my father’, ‘the staff are lovely – they don’t pressure you if you don’t want to do something’, ‘the Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 24 staff are not too bad at all’, ‘we get well looked after’ and ‘they are ever so obliging – coming here was the best thing for me’. A relative said, ‘you can tell the staff talk to people a lot because the residents recognise them’. Surveys received from people stated staff were available and that they listened to people. The manager had completed a training plan for the coming year, which covered mandatory training, and service specific courses. A training matrix was available in the managers’ office to record when staff had completed the training and when updates were due. The mode of training included in-house videos followed by questionnaires to test comprehension, distance learning, external facilitators and a range of courses provided by the local authority. There was evidence that the manager had arranged for health personnel to instruct care staff in stoma care prior to the admission of a resident with specific needs. The manager had also completed a resource pack which included conditions affecting older people such as Parkinson’s disease, diabetes, chronic obstructive airways disease, Alzheimer’s disease, infections and strokes. The pack also covered management of pressure ulcers, catheters, and epilepsy, and had information about palliative care. The resource packs were given to all staff and they were expected to work through the questionnaires attached to each section. Staff could then identify where they needed further training. The in-house induction booklets examined covered lots of areas and policies and procedures but did not cover the common induction standards included in skills for care booklets. The manager was advised to obtain this information and incorporate it into the induction process. This will ensure that staff members’ competence in meeting the standards can be assessed and signed off by management on completion of their induction. According to information received on the day the home had eleven care staff that had completed a national vocational qualification (NVQ) at levels 2 and 3. This equated to 57 , which is a very good achievement and has exceeded the requirement for 50 of care staff trained to this level. There were a further two staff awaiting validation of their work towards the award and other staff progressing through levels 2 and 3. The home made sure that people had checks prior to starting work. References and criminal record bureau checks were obtained and checks made against the protection of vulnerable adults register. Care staff members were selected via an interview process. Two new staff members had started employment after a povafirst check but prior to the return of the criminal record bureau check. The manager had contacted the Commission about this at the time and took advice about stringent supervision arrangements until the checks were returned. Staff files were neat and ordered and contained staff photographs. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 25 Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements in the way the home is managed including how residents and others are consulted about the home, the records that are maintained and general health and safety. EVIDENCE: The manager has been in post for approximately three and a half years. She was progressing through her Registered Managers Award but the company supplying the support network had financial difficulties, which has caused her to investigate an alternative course. This should be completed quickly to facilitate an early completion of the course. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 27 The manager has completed a ‘train the trainers’ course in safeguarding adults from abuse and a twelve-week health and safety course with the local authority. She keeps herself up to date with training courses relevant to her role. Staff spoken with described her as, ‘approachable at any time’ and ‘she is always there for you’. Other comments in surveys were, ‘good managerial support to residents and staff’, ‘Theresa is supportive and understanding – she works hard’ and ‘she will deal with concerns immediately’. In surveys staff stated that they had the opportunity to meet with the manager either ‘regularly’ or ‘often’ and information was passed on well between management and staff. In discussion a relative told us, ‘Theresa does an outstanding job – nothing is too much trouble, and she is very calm and always there for us’. The company employs an area manager and there was documentation to evidence their monthly visits to the home in line with regulation 26 of the Care Homes Regulations. The reports were comprehensive and evidenced that the area manager spoke to staff and residents and checked a range of records. The home had a quality assurance process that included audits of internal systems and documentation, and questionnaires, ‘your opinion counts’ to residents and their relatives every three months. The questionnaires were also sent to staff and professional visitors on an annual basis. There was evidence that work sheets were produced when shortfalls were identified and a ‘corrective actions’ register was signed when the work had been completed. The manager had also completed the home’s annual quality assurance assessment (AQAA) when the Commission requested it. This detailed what the home did well and plans for improvements. Staff spoken with stated that there continues to be improvements in the home and all stated they enjoyed coming to work, ‘it really has changed for the better’, ‘the atmosphere is lovely’ and ‘we are always looking for ways to make it better for everyone so they feel like it’s their home’. Meetings for residents and staff were held and people were able to make suggestions about the running of the home. Morale had improved and the home in general looked better. Generally families managed finances although the home held a small amount of personal allowance for most people, which was overseen by the administrator. This was usually for hairdressing, chiropody and small purchases. Individual records were maintained and two signatures for transactions. Receipts were obtained for money deposited into the personal allowance system and when staff members assisted people to purchase items from local shops and on outings. Some residents were still able to manage their money and lockable facilities were available in bedrooms to store personal possessions or finances. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 28 We checked staff supervision records and documentation indicated that care staff members were on track to receive the required six formal one to one sessions with their line manager. The supervision covered a range of topics including staff practice, issues arising from their key worker role with residents, training, exchanges of information, and policies and procedures. Staff also had an annual appraisal to discuss their development. The home was a safe place for residents to live in and staff to work in. Equipment was serviced as required and the building was well maintained. Fire alarm checks and drills were carried out and staff received fire safety training to ensure they were aware of what to do in a fire emergency. The home had three residents that had been assessed for the use of bedrails. One set of rails was integrated with the bed and the others were fixed to divan beds. One of the bedrails checked had come loose at one end. Care staff checked the position of bedrails on a daily basis and maintenance personnel checked they continued to be serviceable. We accepted the explanation that the rail may have been dislodged during bed-making. The loose rail was rectified during the visit. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 29 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 3 3 Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 30 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 Standard OP7 Regulation 15 Requirement Now that the home has gathered information regarding one persons’ specific behaviour, this information must be used to formulate a clear behaviour management plan. Timescale for action 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. 1 2 3 Refer to Standard OP7 OP31 OP30 Good Practice Recommendations Care plans should reflect how peoples’ skills relating to independence could be maintained and promoted. The registered manager should continue working towards completion of the Registered Managers Award. Skills for care induction standards should be used as part of the homes induction process to assess the competence of new staff working in the home. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 31 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. Sycamore House DS0000070917.V376767.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!